Rural hospitals and volume standards in surgery

Area of Science:

• Health Services Research
• Surgical Outcomes
• Rural Health Policy

Background:

• Assessing the impact of volume-based referral policies on rural healthcare access.
• Estimating the distribution of low-volume surgical procedures between rural and urban facilities.

Purpose of the Study:

• To determine the proportion of low-volume operations performed in rural versus urban hospitals.
• To inform potential policy changes regarding surgical procedure referrals based on hospital volume.

Main Methods:

• Observational study of national Medicare data (1999-2001) for 12 high-risk operations.
• Categorization of hospitals by geographic location (urban, rural large town, rural small town) using Rural-Urban Commuting Area Codes.
• Definition of low-volume hospitals based on the two lowest quintiles for each procedure.

Main Results:

• The majority of all 12 surgical procedures were performed in urban areas (76%-96%).
• Even among low-volume hospitals, most cases occurred in urban settings (55%-94%).
• Procedures with a stronger volume-outcome effect (e.g., pancreatic resection) were more concentrated in urban areas.

Conclusions:

• Most low-volume surgical operations are concentrated in urban hospitals.
• Referral policies directing patients to high-volume centers can achieve benefits without significantly impacting rural hospitals.