412 IDENTIFICATION OF UNDERSERVED AREAS FOR UROLOGIC CANCER CARE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2012412 IDENTIFICATION OF UNDERSERVED AREAS FOR UROLOGIC CANCER CARE John Gore, Jonathan Wright, Jason Izard, Jonathan Harper, and Michael Porter John GoreJohn Gore Seattle, WA More articles by this author , Jonathan WrightJonathan Wright Seattle, WA More articles by this author , Jason IzardJason Izard Seattle, WA More articles by this author , Jonathan HarperJonathan Harper Seattle, WA More articles by this author , and Michael PorterMichael Porter Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Geographic delineation of the delivery of urologic care would aid regional quality improvement initiatives intended to maximize health outcomes for urologic patients. We sought to define patterns of care for patients requiring urologic cancer surgery based on their region of residence. METHODS We accessed the Washington State Comprehensive Hospital Abstract Reporting System (CHARS) for the years 2003-2007 and examined the ZIP code of residence for patients undergoing radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), radical cystectomy (RC), and transurethral resection of the prostate (TURP). Through linkage of patient residential ZIP codes with the Dartmouth Atlas Hospital Service Area (HSA) and Hospital Referral Region (HRR) designations, we identified geographical areas where most patients get their local hospital care (65 exclusive HSAs in Washington) and their complex surgical care (6 exclusive HRRs in Washington), respectively. We compared care out of HSA and out of HRR for each urological oncology procedure with patients undergoing TURP. RESULTS Patients did not receive surgical treatment of their cancer in their HSA in 46% of RP cases, 45% of RN cases, 47% of PN cases, and 53% of RC cases compared with 30% of TURP cases (p<0.001 for all). Patients underwent surgery outside their HRR in 17% of RP cases, 15% of RN cases, 19% of PN cases, and 24% of RC cases, compared with 7% of TURPs (p<0.001 for all). More than half of patients traveled out of HRR for surgery in 7 HSAs for RP (11%), 3 HSAs for RN (5%), 10 HSAs for PN (15%), and 14 HSAs for RC (22%) compared with none for TURP. CONCLUSIONS Higher levels of surgical complexity mandate a larger burden of travel on patients to access care. Although patients could access TURP regardless of their HSA, many patients had to travel to different HSAs and even different HRRs to access urologic cancer care. RC remains most burdensome, consistent with prior reports of the urbanization of RC care. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e168-e169 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Gore Seattle, WA More articles by this author Jonathan Wright Seattle, WA More articles by this author Jason Izard Seattle, WA More articles by this author Jonathan Harper Seattle, WA More articles by this author Michael Porter Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...