title: Empirical analysis of domestic medical travel for elective cardiovascular procedures.
abstract: OBJECTIVE
  To investigate whether domestic medical travel (DMT; traveling outside of one's home region but within the United States for medical care) and surgeon volume affect clinical outcomes and costs for patients undergoing elective cardiovascular procedures.
  
  
  METHODS
  Retrospective, cross-sectional analysis of patient discharge data from US academic medical centers.
  
  
  METHODS
  Patients were classified as medical travelers if they received elective, nonemergent care more than 250 miles from home. High-volume surgeons (HVSs) were those above the 75th percentile compared with other study surgeons in the annual number of cardiovascular surgeries performed. Multivariable regression models were fit to test the relationships among complications, mortality, length of stay (LOS), cost, DMT status, and surgeon volume, controlling for sociodemographic and clinical factors.
  
  
  RESULTS
  Patients who traveled to HVSs were more likely to be male, white, have lower severity of illness, and have health insurance through an indemnity plan or preferred provider organization with coverage outside of the patient's home region. Patients who traveled to HVSs had shorter LOS and fewer complications than those who received care from local, low-volume surgeons. There was no significant difference in mortality between travelers and nontravelers.
  
  
  CONCLUSIONS
  Patients who travelled to HVSs for elective cardiovascular procedures had outcomes similar to or better than those of patients who received care locally from low-volume surgeons. We found no increase in complications or LOS, despite potentially complex logistical arrangements required by travelers. More work is needed to evaluate the potential of DMT to improve the value of care provided for selected procedures.
authors.affiliation: UHC, 155 North Wacker Dr, Chicago, IL 60606. E-mail: langley@uhc.edu.
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Langley
authors.forename: Tricia J
authors.initials: TJ
authors.lastname: Johnson
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Meurer
authors.forename: Andy N
authors.initials: AN
authors.lastname: Garman
mesh_terms: D002318:Cardiovascular Diseases / Q000601:surgery*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D036262:Empirical Research; D005260:Female; D006801:Humans; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States