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Access to Quaternary Care Surgery: Implications for Accountable Care Organizations.

Abstract：

BACKGROUND:Accountable care organizations (ACOs) attempt to provide the most efficient and effective care to patients within a region. We hypothesized that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. STUDY DESIGN:All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented ZIP code and predicted risk, who underwent surgery at our institution (2005 to 2014), were evaluated. Google Maps calculated travel times, and patients were stratified by 1 hour of travel (local vs regional). Multivariable logistic regression and Cox proportional hazard models were used to evaluate the NSQIP risk-adjusted effects of travel time on operative morbidity, mortality, and long-term survival. RESULTS:Median travel time was 65 minutes, with regional patients demonstrating significantly higher rates of ascites, hypertension, diabetes, disseminated cancer, >10% weight loss, higher American Society of Anesthesiologists (ASA) score, higher predicted risk of morbidity and mortality, and lower functional status (all p < 0.01). After adjusting for ACS NSQIP-predicted risk, travel time was not significantly associated with 30-day mortality (odds ratio [OR] 1.06; p = 0.42) or any major morbidities (all p > 0.05). However, survival analysis demonstrated that travel time is an independent predictor of long-term mortality (OR 1.24; p < 0.001). CONCLUSIONS:Patients traveling farther for care at a quaternary center had higher rates of comorbidities and predicted risk of complications. Additionally, travel time predicts risk-adjusted long-term mortality, suggesting a major focus of ACOs will need to be integration of care at the periphery of their region.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Mehaffey JH,Hawkins RB,Mullen MG,Meneveau MO,Schirmer B,Kron IL,Jones RS,Hallowell PT

doi

10.1016/j.jamcollsurg.2016.12.017

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

525-529

issue

4

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(16)31708-2

journal_volume

224

pub_type

杂志文章

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