Abstract
To determine travel patterns for patients undergoing gastrectomy for cancer and to identify factors associated with patient decision. Support for regionalization of complex surgery grows; however, little is known about the willingness of patients to travel for care. Furthermore, utilization of outcomes data in patients' hospital selection processes is not well understood. Analysis of the California Office of Statewide Health Planning and Development database from 1996 to 2009. Outcome measures included total distance traveled and rate of bypassing the nearest gastrectomy-performing hospitals. Multivariate analyses to identify predictors of bypassing local hospitals were performed. Total study population was 10,022. Majority (67.1%) of patients underwent gastrectomy at the nearest providing hospitals. Distance traveled to destination hospitals in California averaged 17.04 miles. Bypassing patients traveled approximately 16 miles beyond the nearest hospitals to receive care, selecting lower volume destination hospitals in 27.9% of cases. Annual gastrectomy volumes for nearest and for destination hospitals averaged 4.4 and 6.8 cases, respectively, and inhospital mortality rates were 5.9% and 4.8%, respectively. A few patients (19.2%) sought care at teaching hospitals. Rural county residence significantly reduced the likelihood of bypass (P < 0.001). High volume (>7 cases) and teaching status of destination hospitals (both P < 0.001) were predictive of hospital bypass, though no significant association between mortality rate and bypass was identified. The majority of gastric cancer patients underwent gastrectomy at providing hospitals nearest to home, reflecting little regionalization of gastrectomy in California. Patients' hospital selection appears not to be driven by outcomes data.
Highlights
There has been an increasing emphasis on the quality of US healthcare delivery in recent decades
For instance, found that patients preferred to undergo high-risk surgery at local hospitals even in the face of markedly high mortality rates when compared to regionalized centers.[10]
Average in-hospital mortality rates exceeded 5% among all hospitals, with increasing mortality rates observed as gastrectomy performance volume decreased
Summary
There has been an increasing emphasis on the quality of US healthcare delivery in recent decades. Following documentation of widespread medical errors in the Institute of Medicine’s 1999 report entitled To Err is Human, healthcare delivery systems throughout the nation began launching countless measures to improve quality of care.[1] Likewise, researchers began focusing their efforts on ascertaining the effects of these measures on quality improvement.[2,3,4,5] In an effort to establish accountability and achieve better quality improvement, various governmental and nongovernmental groups have advocated for greater transparency, releasing data for review by the general public This has ignited a proliferation of new quality measures and reporting initiatives over recent years, yet some have viewed this massive expanse of information to be overwhelming and difficult for the public to interpret.[6]. Much more research is needed to understand to what extent, if at all, patients incorporate publicly available quality data into their decision-making processes
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