Impact of travel time on healthcare costs and resource utilization by phase of care for older cancer patients.

Abstract

6560 Background: Closures of hospitals and clinics may have unintended consequences, including increasing patient travel time. Increased patient travel time to healthcare facilities has the potential to adversely impact patient outcomes. Limited data exist on the impact of travel time on healthcare costs and resource utilization. Methods: This retrospective cohort study from 2012-2015 evaluated drive time to cancer care site for Medicare beneficiaries age ≥ 65 in the Southeastern US. The primary outcome was Medicare spending by phase of care (initial, survivorship, end of life [EOL]). Secondary outcomes included resource utilization measured by hospitalization rates, hospitalization sites, intensive care unit (ICU) admissions, and chemotherapy-related hospitalization rates. Hierarchical linear models with patients clustered within cancer care site and adjusted for pertinent covariates were used to determine the effects of drive time on average monthly phase-specific Medicare spending. Results: Median drive time was 32 minutes (IQR 18-59) for the 23,382 included Medicare beneficiaries, with 24% of patients driving > 1 hour to their cancer care site. During the initial phase of care, Medicare spending was 14% higher for patients traveling > 1 hour than those traveling ≤ 30 minutes.Hospitalizationrates were 4-13% higher for patients traveling > 1 hour vs. ≤ 30 minutes in the initial (61 vs. 54), survivorship (27 vs. 26), and EOL (310 vs. 86) phases of care (all p < .05). The majority of patients traveling > 1 hour were hospitalized at a local hospital rather than at their cancer care site, whereas the converse was true for patients traveling ≤ 30 minutes. Conclusions: As healthcare locations close, patients living farther from treatment sites may experience more limited access to care, and healthcare spending could increase for Medicare.