Access to Quaternary Care Surgery: Implications for Accountable Care Organizations

J. Hunter Mehaffey, Robert B. Hawkins, Matthew G. Mullen, Max O. Meneveau, Bruce Schirmer, Irving L. Kron, R. Scott Jones, Peter T. Hallowell

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background Accountable care organizations (ACOs) attempt to provide the most efficient and effective care to patients within a region. We hypothesized that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. Study Design All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented ZIP code and predicted risk, who underwent surgery at our institution (2005 to 2014), were evaluated. Google Maps calculated travel times, and patients were stratified by 1 hour of travel (local vs regional). Multivariable logistic regression and Cox proportional hazard models were used to evaluate the NSQIP risk-adjusted effects of travel time on operative morbidity, mortality, and long-term survival. Results Median travel time was 65 minutes, with regional patients demonstrating significantly higher rates of ascites, hypertension, diabetes, disseminated cancer, >10% weight loss, higher American Society of Anesthesiologists (ASA) score, higher predicted risk of morbidity and mortality, and lower functional status (all p < 0.01). After adjusting for ACS NSQIP-predicted risk, travel time was not significantly associated with 30-day mortality (odds ratio [OR] 1.06; p = 0.42) or any major morbidities (all p > 0.05). However, survival analysis demonstrated that travel time is an independent predictor of long-term mortality (OR 1.24; p < 0.001). Conclusions Patients traveling farther for care at a quaternary center had higher rates of comorbidities and predicted risk of complications. Additionally, travel time predicts risk-adjusted long-term mortality, suggesting a major focus of ACOs will need to be integration of care at the periphery of their region.

Original languageEnglish (US)
Pages (from-to)525-529
Number of pages5
JournalJournal of the American College of Surgeons
Volume224
Issue number4
DOIs
StatePublished - Apr 1 2017

ASJC Scopus subject areas

  • Surgery

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    Mehaffey, J. H., Hawkins, R. B., Mullen, M. G., Meneveau, M. O., Schirmer, B., Kron, I. L., Jones, R. S., & Hallowell, P. T. (2017). Access to Quaternary Care Surgery: Implications for Accountable Care Organizations. Journal of the American College of Surgeons, 224(4), 525-529. https://doi.org/10.1016/j.jamcollsurg.2016.12.017