Zhi Ven Fong1, Andrew P Loehrer2, Carlos Fernández-Del Castillo3, Yanik J Bababekov3, Ginger Jin3, Cristina R Ferrone3, Andrew L Warshaw3, Lara N Traeger4, Matthew M Hutter3, Keith D Lillemoe3, David C Chang3. 1. Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: zfong@partners.org. 2. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 3. Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 4. Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: A minimum-volume policy restricting hospitals not meeting the threshold from performing complex operation may increase travel burden and decrease spatial access to operation. We aim to identify vulnerable populations that would be sensitive to an added travel burden. METHODS: We performed a retrospective analysis of the database of the California Office of Statewide Health Planning and Development for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed was used as a metric for travel. Patients bypassing fewer hospitals were deemed to be more sensitive to an added travel burden. RESULTS: There were 13,374 patients who underwent a pancreatectomy, of whom 2,368 (17.7%) were nonbypassers. On unadjusted analysis, patients >80 year old travelled less than their younger counterparts, bypassing a mean of 10.9 ± 9.5 hospitals compared with 14.2 ± 21.3 hospitals bypassed by the 35-49 year old age group (P < .001). Racial minorities travelled less when compared with non-Hispanic whites (P < .001). Patients identifying their payer status as self-pay (8.9 ± 15.6 hospitals bypassed) and Medicaid (10.1 ± 17.2 hospitals bypassed) also travelled less when compared with patients with private insurance (13.8 ± 20.4 hospitals bypassed, P < .001). On multivariate analysis, advanced age, racial minority, and patients with self-pay or Medicaid payer status were associated independently with increased sensitivity to an added travel burden. CONCLUSION: In patients undergoing pancreatectomy, the elderly, racial minorities, and patients with self-pay or Medicaid payer status were associated with an increased sensitivity to an added travel burden. This vulnerable cohort may be affected disproportionately by a minimum-volume policy.
BACKGROUND: A minimum-volume policy restricting hospitals not meeting the threshold from performing complex operation may increase travel burden and decrease spatial access to operation. We aim to identify vulnerable populations that would be sensitive to an added travel burden. METHODS: We performed a retrospective analysis of the database of the California Office of Statewide Health Planning and Development for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed was used as a metric for travel. Patients bypassing fewer hospitals were deemed to be more sensitive to an added travel burden. RESULTS: There were 13,374 patients who underwent a pancreatectomy, of whom 2,368 (17.7%) were nonbypassers. On unadjusted analysis, patients >80 year old travelled less than their younger counterparts, bypassing a mean of 10.9 ± 9.5 hospitals compared with 14.2 ± 21.3 hospitals bypassed by the 35-49 year old age group (P < .001). Racial minorities travelled less when compared with non-Hispanic whites (P < .001). Patients identifying their payer status as self-pay (8.9 ± 15.6 hospitals bypassed) and Medicaid (10.1 ± 17.2 hospitals bypassed) also travelled less when compared with patients with private insurance (13.8 ± 20.4 hospitals bypassed, P < .001). On multivariate analysis, advanced age, racial minority, and patients with self-pay or Medicaid payer status were associated independently with increased sensitivity to an added travel burden. CONCLUSION: In patients undergoing pancreatectomy, the elderly, racial minorities, and patients with self-pay or Medicaid payer status were associated with an increased sensitivity to an added travel burden. This vulnerable cohort may be affected disproportionately by a minimum-volume policy.
Authors: Paul J Speicher; Brian R Englum; Asvin M Ganapathi; Xiaofei Wang; Matthew G Hartwig; Thomas A D'Amico; Mark F Berry Journal: Ann Surg Date: 2017-04 Impact factor: 12.969
Authors: Luke M Funk; Atul A Gawande; Marcus E Semel; Stuart R Lipsitz; William R Berry; Michael J Zinner; Ashish K Jha Journal: Ann Surg Date: 2011-05 Impact factor: 12.969
Authors: Michael E Lidsky; Zhifei Sun; Daniel P Nussbaum; Mohamed A Adam; Paul J Speicher; Dan G Blazer Journal: Ann Surg Date: 2017-08 Impact factor: 12.969
Authors: Grace C Lee; T Clark Gamblin; Zhi Ven Fong; Cristina R Ferrone; Lipika Goyal; Keith D Lillemoe; Lawrence S Blaszkowsky; Kenneth K Tanabe; Motaz Qadan Journal: Ann Surg Oncol Date: 2019-07-31 Impact factor: 5.344
Authors: Christian Lopez Ramos; Michael G Brandel; Robert C Rennert; Brian R Hirshman; Arvin R Wali; Jeffrey A Steinberg; David R Santiago-Dieppa; Mitchell Flagg; Scott E Olson; J Scott Pannell; Alexander A Khalessi Journal: Neurosurgery Date: 2020-02-01 Impact factor: 4.654
Authors: Zhi Ven Fong; Daniel A Hashimoto; Ginger Jin; Alex B Haynes; Numa Perez; Motaz Qadan; Cristina R Ferrone; Carlos Fernandez-Del Castillo; Andrew L Warshaw; Keith D Lillemoe; Lara N Traeger; David C Chang Journal: Ann Surg Date: 2021-08-01 Impact factor: 12.969
Authors: Elliott K Yee; Natalie G Coburn; Victoria Zuk; Laura E Davis; Alyson L Mahar; Ying Liu; Vaibhav Gupta; Gail Darling; Julie Hallet Journal: Gastric Cancer Date: 2021-02-06 Impact factor: 7.370
Authors: Zhi Ven Fong; Pei-Wen Lim; Ryan Hendrix; Carlos Fernandez-Del Castillo; Ryan D Nipp; James M Lindberg; Giles F Whalen; William Kastrinakis; Motaz Qadan; Cristina R Ferrone; Andrew L Warshaw; Keith D Lillemoe; David C Chang; Lara N Traeger Journal: Ann Surg Oncol Date: 2021-01-07 Impact factor: 4.339