Utilization of low-volume hospitals for total hip replacement.
OBJECTIVE
To identify factors associated with utilization of low-volume hospitals for total hip replacement (THR) and to estimate differences in the distances that Medicare beneficiaries had to travel to reach low- or high-volume hospitals.


METHODS
We studied a population-based sample of 1,146 Medicare beneficiaries who underwent elective THR in 1995. Using multiple data sources including medical record review, Medicare claims data, 1990 Census data, and a patient survey, we examined factors independently associated with utilization of low-volume hospitals for elective THR. We estimated the magnitude of difference in distances for patients undergoing THR in low- and high-volume hospitals. We determined the distance between each patient's residence and the treating hospital using MapQuest.


RESULTS
Rural residency, low income, and low educational attainment, as well as belief in the importance of convenient location in the choice of hospital, were associated with higher utilization of low-volume hospitals. Rural and suburban patients who went to low-volume hospitals traveled much less than patients operated upon in high-volume centers.


CONCLUSIONS
Policies aimed at restricting THR to high-volume centers would differentially affect poor, less educated, and rural patients. Voluntary efforts to shift THR to high-volume centers should involve educating these patients and their referring physicians about differences in both short-term and longer-term outcomes between high- and low-volume centers.
Boston University School of Public Health and Robert B. Brigham Arthritis Clinical Research Center, Boston, Massachusetts, USA. lenal@bu.edu
Elena
E
Losina
Jane
J
Barrett
John A
JA
Baron
Matthew
M
Levy
Charlotte B
CB
Phillips
Jeffrey N
JN
Katz
D000368:Aged; D001168:Arthritis / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010020:Osteonecrosis / Q000601:surgery; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D011153:Population; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome