Emergence of integrated urology-radiation oncology practices in the State of Texas.
OBJECTIVE
Integrated urology-radiation oncology (RO) practices have been advocated as a means to improve community-based prostate cancer care by joining urologic and radiation care in a single-practice environment. However, little is known regarding the scope and actual physical integration of such practices. We sought to characterize the emergence of such practices in Texas, their extent of physical integration, and their potential effect on patient travel times for radiation therapy.


METHODS
A telephone survey identified integrated urology-RO practices, defined as practices owned by urologists that offer RO services. Geographic information software was used to determine the proximity of integrated urology-RO clinic sites with respect to the state's population. We calculated patient travel time and distance from each integrated urology-RO clinic offering urologic services to the RO treatment facility owned by the integrated practice and to the nearest nonintegrated (independent) RO facility. We compared these times and distances using the Wilcoxon-Mann-Whitney test.


RESULTS
Of 229 urology practices identified, 12 (5%) offered integrated RO services, and 182 (28%) of 640 Texas urologists worked in such practices. Approximately 53% of the state population resides within 10 miles of an integrated urology-RO clinic site. Patients with a diagnosis of prostate cancer at an integrated urology-RO clinic site travel a mean of 19.7 miles (26.1 min) from the clinic to reach the RO facility owned by the integrated urology-RO practice vs 5.9 miles (9.2 min) to reach the nearest nonintegrated RO facility (P<.001).


CONCLUSIONS
Integrated urology-RO practices are common in Texas and are generally clustered in urban areas. In most integrated practices, the urology clinics and the integrated RO facilities are not at the same location, and driving times and distances from the clinic to the integrated RO facility exceed those from the clinic to the nearest nonintegrated RO facility.
Section of Radiation Oncology, Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.
Pavan M
PM
Jhaveri
Zhuyi
Z
Sun
Leslie
L
Ballas
David S
DS
Followill
Karen E
KE
Hoffman
Jing
J
Jiang
Benjamin D
BD
Smith
D040362:Geographic Information Systems; D006123:Group Practice / Q000458:organization & administration / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D010067:Ownership / Q000706:statistics & numerical data; D011364:Professional Practice / Q000458:organization & administration* / Q000639:trends; D011365:Professional Practice Location / Q000706:statistics & numerical data* / Q000639:trends; D018787:Radiation Oncology / Q000458:organization & administration* / Q000639:trends; D018709:Statistics, Nonparametric; D013781:Texas; D013997:Time Factors; D014572:Urology / Q000458:organization & administration* / Q000639:trends; D000078329:Workforce