Simulated Volume-Based Regionalization of Complex Procedures: Impact on Spatial Access to Care

Area of Science:

• Health Services Research
• Surgical Outcomes
• Healthcare Policy

Background:

• Policies aiming to centralize complex surgeries at high-volume centers may improve patient outcomes.
• The impact of such regionalization strategies on patient access, particularly driving times, remains largely unquantified.

Purpose of the Study:

• To simulate the regionalization of pancreatectomy procedures.
• To assess the impact of this regionalization on patient spatial access, measured by driving times.
• To evaluate the potential trade-offs between improved surgical outcomes and patient accessibility.

Main Methods:

• Utilized California's statewide database to identify patients undergoing pancreatectomies (2005-2014).
• Calculated round-trip driving times using Google Maps between patient residences and hospitals.
• Simulated regionalization by excluding hospitals with fewer than 20 pancreatectomies annually and reassigning patients to the nearest qualifying high-volume center.
• Conducted sensitivity analyses for New York and Medicare populations to examine geographical and insurance influences.

Main Results:

• Nearly half (47.6%) of pancreatectomies were performed at low-volume centers (<20 cases/year).
• Simulated regionalization increased median round-trip driving time by 24.1 minutes, with a 25% increase exceeding 53.5 minutes.
• Projected in-hospital mortality decreased from 6.7% to 2.8% (P < 0.001), with affected patients more likely to be minorities or have Medicaid/uninsured status.
• Sensitivity analyses showed increased driving times of 17.8 minutes in New York and 27.0 minutes for Medicare patients.

Conclusions:

• Centralizing pancreatectomy care to high-volume hospitals significantly increases patient travel time, by a median of 24 minutes.
• This policy shift is associated with a substantial reduction in mortality rates, suggesting a potential improvement in overall patient outcomes.
• The increased travel burden disproportionately affects minority and socioeconomically disadvantaged populations, highlighting equity concerns in regionalization strategies.