Impact of Volume-Based Regionalization on Access to Care in Patients Undergoing Pancreatectomy

项目总结/摘要 医院容量已被证明与手术死亡率呈负相关， 复杂的手术自从它的概念普及以来，一直在推动基于体积的 胰腺切除术的区域化在过去的一年里，三大卫生系统实施了最低限度的- 数量标准，将禁止医院和外科医生不符合门槛， 复杂的手术，并正在推动其他卫生系统承诺低容量的门槛， 任务。 然而，这种区域化战略对患者偏好和获得 护理仍不清楚。胰腺切除术已经证明了 数量和死亡率，并代表了程序，站在获得最大的从这样一个 政策然而，国家数据表明，高达70%的早期胰腺癌患者 癌症不接受手术干预，其中少数民族，医疗补助和 没有保险的人占这一群体的大多数。这被假设为是次要的虚无主义 对疾病和手术的复杂性需要长期生存的希望。作为 因此，拟议的低数量阈值授权可能会造成意想不到的后果， 更多的限制病人接受治疗。 初步数据表明，上述弱势群体往往旅行， 胰腺切除术距离较短，往往在质量较差的医院进行手术。 本研究的目的是评估拟议的低容量阈值的潜在影响 对接受胰腺切除术的患者进行护理的授权。具体来说，我们将从数量上 评估在以下情况下对患者所需旅行距离和总体死亡率的影响： 所有的病人都被转移到高容量的中心， 旅行的可能性没有得到照顾。此外，我们将对 患者在接受治疗时所面临的促进因素和限制因素。 完成后，这项研究将提供新的数据，突出显示基于数量的 在获得护理方面实行区域化。此外，它将提请注意减少目前的差距， 弱势群体的医疗保健质量和可及性，并为干预措施提供信息， 缓解这一问题，这是国家普通医学科学研究所的核心目标。最后，我们的研究 将为研究提供更适当的质量衡量标准，而不是数量，因为数量可能 过于简单化一个复杂的问题和一个危险的指标来激励医院。

Project Summary/Abstract Hospital volume has been shown to be inversely correlated with surgical mortality rates in complex surgery. Since the popularization of its concept, there has been a push towards volume-based regionalization of pancreatectomy. This past year, three major health systems have imposed minimum- volume standards that will bar hospitals and surgeons not meeting the threshold from performing complex surgery, and are pushing for other health systems to pledge to the low-volume threshold mandate. However, the impact of such a regionalization strategy on patient preferences and access to care remains unclear. Pancreatectomy has demonstrated the most pronounced association between volume and mortality rates, and represents the procedure that stands to gain the most from such a policy. However, national data demonstrates that up to 70% of patients with early stage pancreatic cancer do not receive surgical intervention, of which racial minorities, patients on Medicaid and the uninsured make up the majority of this cohort. This was hypothesized to be secondary to nihilism towards the disease and the complexity of the operation needed for hopes of long-term survival. As such, a proposed low-volume threshold mandate may cause unintended consequences by exerting more constraints on patients to receive care. Preliminary data has demonstrated that the vulnerable cohort as described above tend to travel shorter distances for pancreatectomy, and often undergo the surgery at hospitals with poorer quality. The objective of this study is to assess the potential impact of the proposed low-volume threshold mandate on access to care in patients undergoing pancreatectomy. Specifically, we will quantitatively assess the impact on distance needed to travel by patients and overall mortality rates in a setting where all patients are redirected to high-volume centers, and a simulated setting where patients with lower likelihood of travelling do not receive care. Additionally, we will perform qualitative assessment of the facilitators and constraints that patients face to receive care. When completed, this study will provide novel data highlighting the impact of volume-based regionalization on access to care. Additionally, it will bring attention to reduce current disparities in health care quality and access with respect to vulnerable populations, and inform interventions to alleviate the issue, a core goal of the National Institute of General Medical Sciences. Lastly, our study will provide stimulus for research in more appropriate measures of quality than volume, as volume may be over-simplifying a complex issue and a dangerous metric to be incentivizing hospitals on.