Patient Preferences for Location of Care

Finlayson, Samuel R.G.; Birkmeyer, John D.; Tosteson, Anna N.A.; Nease, Robert F.

doi:10.1097/00005650-199902000-00010

Cited by 412 publications

(251 citation statements)

References 22 publications

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“…Regionalization and selective referral could result inevitably in adverse outcomes by limiting patient choice and access to care, increasing unreasonable transfer and travel burdens and reducing the availability of surgical services in many locations, particularly in rural areas remote from the high-volume centers. (94,95) The volume-based referral policy also may have unintended consequences for patients at lower-volume hospitals who have conditions that are not on the selective referral list. (79) Third, patients might not benefit equally from regionalization or selective referrals.…”

Section: The Volume-based Policies In Risky Surgeries and Transplantmentioning

confidence: 99%

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Lee¹,

Ts'ao²,

Loong³

2012

Current Concepts in Kidney Transplantation

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Section: The Volume-based Policies In Risky Surgeries and Transplantmentioning

confidence: 99%

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Lee¹,

Ts'ao²,

Loong³

2012

Current Concepts in Kidney Transplantation

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“…[36][37][38][39] Referral to highvolume centers is often met with resistance by both patients and providers, leads to disparities in which minorities and the underinsured are less likely to receive referral to a high-volume center, and is problematic in many regions that lack high-volume facilities. [36][37][38][39] Furthermore, for lower-risk patients undergoing high-risk surgery, the benefits of volume-based referral are questionable; it appears that the greatest benefits are derived in the highest-risk patient population undergoing the highest risk surgeries. 40 Given these difficulties, some authors have suggested that regionalization should primarily be encouraged for high morbidity procedures with strong volume-outcome relationships like pancreatectomy and esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Trends in hospital volume and patterns of referral for women with gynecologic cancers

Wright

Herzog

Burke

et al. 2013

Gynecologic Oncology

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“…5,13,14 However, it has been shown that patients prefer to see physicians closer to home, despite a possibly higher mortality. 23 Primary care physicians may also wish to refer patients to specialists based on qualities such as appointment timeliness and communication. 24 There is a possibility that rural patients are underserved by urban centres despite idealistic intentions.…”

Section: Discussionmentioning

confidence: 99%

Adding an endovascular aortic surgery program to a rural regional medical centre

Marelli¹,

Woo²,

Watson³

et al. 2013

Can J Surg

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E105 RESEARCH • RECHERCHEAdding an endovascular aortic surgery program to a rural regional medical centre Background: Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods:A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results:In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55-89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion:Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable.Contexte : Les anévrismes de l'aorte abdominale justiciables d'une intervention chirurgicale sont généralement traités par voie endovasculaire. Ce type d'intervention n'est toutefois pas toujours pratiqué dans les hôpitaux ruraux. Les patients peuvent donc s'en trouver moins bien desservis. Nous avons passé en revu notre expérience après la mise sur pied d'un programme de chirurgie endoaortique.Méthodes : Grâce à une collaboration avec un centre universitaire, un chirurgien d'un centre rural a reçu l'agrément nécessaire pour effectuer la réparation endovasculaire des anévrismes de l'aorte et il a été supervisé localement pour les 5 premières réparations d'anévrisme de l'aorte abdominale. Une banque d'images sur le Web a permis de passer en revue des cas complexes dans le cadre d'un partenariat continu. On a fait subir aux patients adressés en consultation un dépistage d'anévrismes multiples et ils ont fait l'objet d'un suivi à long terme.

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Patient Preferences for Location of Care

Abstract: Many patients prefer to undergo surgery locally even when travel to a regional center would result in lower operative mortality risk. Therefore, policy makers should consider patient preferences when assessing the expected value of regionalizing major surgery.

Cited by 412 publications

References 22 publications

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Trends in hospital volume and patterns of referral for women with gynecologic cancers

Adding an endovascular aortic surgery program to a rural regional medical centre

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