The potential impact on patient-hospital travel distance and access to care under a policy of preferential referral to high-volume knee replacement hospitals.
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The potential impact on patient-hospital travel distance and access to care under a policy of preferential referral to high-volume knee replacement hospitals.
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Authors:
Address: Department of Medicine, Division of Rheumatology, University of California, Los Angeles. jfitzgerald@mednet.ucla.edu.
Journal:
Publication:
To examine The potential impact of a policy of selective referral to high-volume knee replacement hospitals on patient-hospital travel distance and access to care for patients seeking total knee replacement (TKR) in urban and rural settings.
The travel distance required for patients to reach their hospital and the additional travel distance required to reach the nearest high-volume hospital were analyzed using a 100% sample of Medicare fee-for-service patients undergoing TKR in 2001.
Of the 183,174 TKR performed in the US during 2001, 95% of patients selected underwent TKR at a hospital that was located within 50 miles of their residence. There were 11,550 patients who had their TKR performed at a low-volume hospital (LVH) where there was no nearer high-volume hospital. The impact of a policy that would direct patients to high-volume hospitals varied by region. In urban areas, the nearest high-volume hospital was a median 3.8 miles further than LVH of service. Patient factors, race and poverty, were associated with selection of LVHs in urban areas. In rural areas, 1,506 patients would have had to travel more than 50 miles and 259 patients would have had to travel more than 100 miles to reach a high-volume hospital.
A policy to direct patients away from LVHs could increase patient-hospital travel time in rural areas and restrict access of minority and low-income patients in urban areas. Any implementation of selective referral to high-volume centers should address access to hospitals for rural patients, urban minority and poor patients.
Copyright © 2012 by the American College of Rheumatology.
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