P3.07-015 Patterns and Risk Factors of Patient Flows across Different Geographic Health Service Units for Lung Cancer Surgery: Topic: Other – Geographical Differences

Abstract

To date lobectomy patient flows across different geographic units and time periods has not been quantified; little is known about associations between hospital- and patient-level factors and travel choices for surgery and the subsequent outcomes. We explored these issues as well as the robustness of the aforementioned associations with changing geographic health service units. The New York Statewide Planning and Research Cooperative System database (2007-2012) was used to select lung cancer patients who underwent lobectomy by Video-Assisted Thoracic Surgery (VATS) or open thoracotomy techniques. Hierarchical logistic regressions were used to examine factors associated with surgeries occurred within or outside of patients’ geographic units: Health Service Regions (HSRs), Health Referral Regions (HRRs), and Health Service Areas (HSAs), respectively. A total of 9,655 lobectomies (43% of which were VATS) from 8 HSRs, 21 HRRs, and 145 HSAs were identified. At the state-level, 17%, 22%, and 56% of the lobectomies occurred outside of patients’ HSRs, HRRs, and HSAs, respectively; the percentages varied spatially but the spatial patterns remained stable from 2007 to 2012. Travel-out patients were more likely to be males or with private insurance, and less likely to be non-Hispanics Blacks, Hispanics, or with Medicaid insurance. Travel-out lobectomies were more likely to be performed by VATS, in urban setting, teaching hospitals, with higher lung surgery volume, and higher numbers of surgeons. In-hospital mortality of travel-out lobectomies was not significantly different from that of the stay-in. These associations were consistent among models using different health service geographic units. Lung cancer patients tended to travel farther to be treated with VATS in urban/teaching hospitals with high surgery and surgeon volumes. Other independent determinants of the travel choice included sex, insurance type, and race/ethnicity. Patients’ choices and preferences should be taken into account when planning specialized health care delivery services.