Barbara A Blanco1, Anai N Kothari1, Robert H Blackwell2, Sarah A Brownlee3, Ryan M Yau3, John P Attisha4, Yoshiki Ezure1, Sam Pappas1, Paul C Kuo1, Gerard J Abood5. 1. Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL. 2. Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL; Department of Urology, Loyola University Medical Center, Maywood, IL. 3. Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL. 4. Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL; Department of Computer Science, DePaul University, Chicago, IL. 5. Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL. Electronic address: gabood@lumc.edu.
Abstract
BACKGROUND: "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. METHODS: Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. RESULTS: Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. CONCLUSION: Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise.
BACKGROUND: "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. METHODS: Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. RESULTS: Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. CONCLUSION: Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise.
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