Justin B Dimick1, Samuel R G Finlayson. 1. VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA. Justin.B.Dimick@Dartmouth.edu
Abstract
BACKGROUND: We sought to understand the potential impact of volume-based referral policy on rural hospitals by estimating the proportion of low-volume operations occurring in rural versus urban hospitals. METHODS: We performed an observational study using the national Medicare population who underwent one of 12 high-risk operations from 1999-2001. Low-volume hospitals were considered those in the 2 lowest quintiles for each procedure. Hospitals were assigned to 1 of 3 types of geographic locations on the basis of Rural-Urban Commuting Area Codes: urban areas, rural large towns, or rural small towns. For each of the 12 operations, we estimated the proportion of patients undergoing operation in low-volume hospitals within each type of geographic area. RESULTS: For all 12 operations, the majority of surgical cases were performed in urban areas (ranging from a low of 76% for colectomy to 96% for heart valve operations). Evaluation of only operations performed in low-volume hospitals showed that the majority of surgical cases were still located in urban areas (varying from a low of 55% for colectomy to a high of 94% for heart valve operations). Operations with a stronger effect of volume on outcome (eg, pancreatic and esophageal resection) were more concentrated in urban areas, compared with operations with a weaker effect (eg, colectomy). CONCLUSIONS: Most low-volume operations take place in urban hospitals. Efforts to direct patients to high-volume hospitals can exempt rural hospitals and still realize most of the potential benefits.
BACKGROUND: We sought to understand the potential impact of volume-based referral policy on rural hospitals by estimating the proportion of low-volume operations occurring in rural versus urban hospitals. METHODS: We performed an observational study using the national Medicare population who underwent one of 12 high-risk operations from 1999-2001. Low-volume hospitals were considered those in the 2 lowest quintiles for each procedure. Hospitals were assigned to 1 of 3 types of geographic locations on the basis of Rural-Urban Commuting Area Codes: urban areas, rural large towns, or rural small towns. For each of the 12 operations, we estimated the proportion of patients undergoing operation in low-volume hospitals within each type of geographic area. RESULTS: For all 12 operations, the majority of surgical cases were performed in urban areas (ranging from a low of 76% for colectomy to 96% for heart valve operations). Evaluation of only operations performed in low-volume hospitals showed that the majority of surgical cases were still located in urban areas (varying from a low of 55% for colectomy to a high of 94% for heart valve operations). Operations with a stronger effect of volume on outcome (eg, pancreatic and esophageal resection) were more concentrated in urban areas, compared with operations with a weaker effect (eg, colectomy). CONCLUSIONS: Most low-volume operations take place in urban hospitals. Efforts to direct patients to high-volume hospitals can exempt rural hospitals and still realize most of the potential benefits.
Authors: Christopher M Dodgion; Bridget A Neville; Stuart R Lipsitz; Deborah Schrag; Elizabeth Breen; Michael J Zinner; Caprice C Greenberg Journal: J Surg Res Date: 2014-03-22 Impact factor: 2.192
Authors: Lindsay A Bliss; Catherine J Yang; Zeling Chau; Sing Chau Ng; David W McFadden; Tara S Kent; A James Moser; Mark P Callery; Jennifer F Tseng Journal: HPB (Oxford) Date: 2014-06-06 Impact factor: 3.647