Does Travel Distance Influence Length of Stay in Elective Colorectal Surgery?

Jackson, Katharine L.; Glasgow, Robert E.; Hill, Britani R.; Mone, Mary C.; Sklow, Bradford; Scaife, Courtney L.; Sheng, Xiaoming; Peche, William

doi:10.1097/dcr.0b013e31827e939e

Cited by 29 publications

(14 citation statements)

References 14 publications

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“…19 Likewise, two studies by Jackson et al demonstrated an effect of distance traveled on length of stay for elective colorectal and pancreatic surgery. 20,21 These studies differed from ours in that the distances traveled in our study were much less (longest average distance 25 miles compared with an average distance over 200 miles). [19][20][21] Within the distances traveled in our study, a concentrated specialized care model is cost effective and does not negatively affect outcomes, although it may be inconvenient and incur increased personal costs for patients.…”

Section: Discussioncontrasting

confidence: 78%

Travel Burden and the Direct Medical Costs of Urologic Surgery

Olson

Gore

Daratha

et al. 2016

JHEOR

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Background: Increased surgical volume is associated with better patient outcomes and shorter lengths of hospitalization. As a consequence, traveling to receive care from a high volume provider may be associated with better outcomes. However, travel may also be associated with a decision by the healthcare provider to increase the length of stay due to a decreased ability to return to the primary hospital should complications arise. Thus, research is needed to understand the relationship between the distance a patient must travel and their outcomes following urologic surgery.Objective: The purpose of this study was to determine whether the distance a patient travels to receive urologic surgery is associated with their length of hospital stay and direct medical hospitalization costs. Methods:This was a retrospective observational cohort study of 12 106 patients over 50 years of age undergoing transurethral resection of the prostate (TURP), radical prostatectomy (RP) or radical cystectomy (RC) in Washington State hospitals between 2009 and 2013. Distance traveled was determined by calculating the linear distance between zip code centroids of patient residence and the hospital performing their procedure. Patients were sorted into four groups classified by distance traveled (≤5 miles, 6-20 miles, 21-50 miles and ≥51 miles) and cost calculated using a charges-to-reimbursement ratio for each hospital. Statistical significance was determined using a Kruskal-Wallis test.Results: Patients traveling greater distances had significantly lower median medical costs compared with patients who lived closer to the hospitals where they underwent TURP and RP (TURP: ≤5 miles, $6243 and ≥51 miles, $5105, p≤0.001; RP: ≤5 miles, $12 407 and ≥51 miles, $11 882, p≤0.001), whereas there was no significant difference for patients undergoing RC (≤5 miles, $27 554 and ≥51 miles, $26 761, p=0.17). Likewise, patients traveling greater distances had significantly lower median lengths of hospitalization for TURP and RP (TURP: p≤0.001, RP: p≤0.001), while there was no difference for RC (p=0.50). Conclusions:Patient travel burden does appear to play a role in cost and length of hospital stay for select urologic procedures with variable levels of morbidity and recovery time. Although these findings are statistically significant, the magnitude of the effect is small.

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Section: Discussioncontrasting

confidence: 78%

Travel Burden and the Direct Medical Costs of Urologic Surgery

Olson

Gore

Daratha

et al. 2016

JHEOR

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“…We have categorised the studies according to the following three groups: Distance decay association —studies that showed evidence of an association between patients living closer to the healthcare facility and having better health outcomes/higher access rates to the healthcare services compared to those living further away (see online supplementary table S2) 714–95…”

Section: Resultsmentioning

confidence: 99%

“…These can be broadly split into revealed accessibility and potential accessibility methods, as defined by Khan. 6 Revealed accessibility refers to methods that use data from actual healthcare trips, for example, the drive time or straight-line distance between a patient's home address and the hospital they attended 78 Potential accessibility refers to methods that look at what is the potential for accessing healthcare facilities in a particular area, for example, using gravity models9 and specialised gravity models—such as, two-step flotation catchment area method 10…”

Section: Introductionmentioning

confidence: 99%

Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

et al. 2016

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ObjectivesTo investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this.DesignSystematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south.SettingsA wide range of settings within primary and secondary care (these were not restricted in the search).Results108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies.ConclusionsThe review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.

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“…Methods to measure spatial accessibility to health care can be broadly divided into two [ 29 ]: revealed accessibility methods and potential accessibility methods. Revealed accessibility refers to methods that use data from actual healthcare trips, for example the drive time or straight-line distance between a patient’s home address and the hospital they attended [ 30 , 31 ]. Potential accessibility refers to methods that look at what is the potential for accessing healthcare facilities in a particular area, for example, using gravity models originally developed by Hansen in 1959 [ 32 ] and specialised gravity models—such as, two-step flotation catchment area method [ 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach

Mahmud

Aljunid

2018

PLoS ONE

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Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent’s residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40–74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8–112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60–78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0–340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40–240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.

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Does Travel Distance Influence Length of Stay in Elective Colorectal Surgery?

Cited by 29 publications

References 14 publications

Travel Burden and the Direct Medical Costs of Urologic Surgery

Travel Burden and the Direct Medical Costs of Urologic Surgery

Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach

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