"Take the Volume Pledge" may result in disparity in access to care Journal Article

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Authors: Blanco, B. A.; Kothari, A. N.; Blackwell, R. H.; Brownlee, S. A.; Yau, R. M.; Attisha, J. P.; Ezure, Y.; Pappas, S.; Kuo, P. C.; Abood, G. J.
Article Title: "Take the Volume Pledge" may result in disparity in access to care
Abstract: BACKGROUND: "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform >/=20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. METHODS: Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing >/=20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. RESULTS: Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. CONCLUSION: Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise.
Journal Title: Surgery
Volume: 161
Issue: 3
ISSN: 1532-7361; 0039-6060
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2017
Start Page: 837
End Page: 845
Language: eng
DOI/URL:

S0039-6060(16)30353-1
Notes: LR: 20170213; CI: Copyright (c) 2016; JID: 0417347; 2016/02/24 [received]; 2016/06/29 [revised]; 2016/07/07 [accepted]; ppublish