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How Far Are Patients Willing to Travel for Gastrectomy?
*David C Chang1, *Joel Adler1, *Abraham Noorbakhsh2, John Mullen1
1Massachusetts General Hospital, Harvard Medical School, Boston, MA;2University of California, San Diego, La Jolla, CA
OBJECTIVE: To determine patterns associated with a patient’s decision to bypass their closest hospital to undergo gastrectomy for gastric cancer.
DESIGN: Cross-sectional study of California Office of Statewide Health Planning and Development database. Multivariate analysis and relative contribution of individual variables were performed, adjusting for patient demographics, hospital teaching status, prior year gastrectomy volume, and prior year mortality rates between destination hospital and closest hospital.
SETTING: California state, 1995-2009.
PATIENTS: 16,942 patients undergoing gastrectomy for gastric cancer.
MAIN OUTCOME MEASURE: Distance travelled beyond the closest hospital.
RESULTS: Median distance that patients travelled was 6.1 miles (IQR 3.1-13.0). The majority of patients (65.8%) received gastrectomy from the closest hospitals. Among those who bypassed the closest hospital, the median distance travelled was 4.53 miles (IQR 1.7-11.7). Median annual gastrectomy volume was 3 (IQR 2-6). Black patients were significantly more likely to travel a shorter distance (2.2 miles). Hospital characteristics associated with increased travel distance were teaching status of destination hospital (8.2 miles) and difference in annual volume between destination versus closest hospitals (0.36 miles/additional case/year). Patient age, gender, comorbidities, insurance status, and mortality rates of hospitals have no significant association. The top three contributors to bypass were volume differences (24.6%), teaching status of the destination hospital (21.6%), and non-teaching status of the closest hospital (9.12%). In contrast, patient characteristics and hospital mortality rates had very small contributions (< 1% each).
CONCLUSIONS: The majority of gastric cancer patients, particularly black patients, underwent gastrectomy at the closest hospitals to their homes, reflecting little regionalization of gastrectomies in California. Patient decision to bypass local hospitals may be driven more by destination hospital reputation than by hospital outcomes data.
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