title: The effects of regionalization on cost and outcome for one general high-risk surgical procedure.
abstract: OBJECTIVE
  The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital.
  
  
  METHODS
  Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed.
  
  
  RESULTS
  Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals. Mortality and cost increased as volume decreased when hospitals were grouped according to volume.
  
  
  CONCLUSIONS
  An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.
authors: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors: T A
authors: TA
authors: Gordon
authors: G P
authors: GP
authors: Burleyson
authors: J M
authors: JM
authors: Tielsch
authors: J L
authors: JL
authors: Cameron
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000191:economics* / Q000401:mortality; D012041:Regional Medical Programs / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors