title: Identification of underserved areas for urologic cancer care.
abstract: BACKGROUND
  The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State.
  
  
  METHODS
  The authors accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2003 through 2007. They identified patients undergoing radical prostatectomy, radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy, and transurethral resection of the prostate (TURP). TURP was included for comparison as a reference procedure indicative of access to urologic care. Hospital service areas (HSAs) are where the majority of local patients are hospitalized; hospital referral regions (HRR) are where most patients receive tertiary care. The authors created multivariate hierarchical logistic regression models to examine patient and HSA characteristics associated with the receipt of urologic oncology care out of the HRR for each procedure.
  
  
  RESULTS
  Greater than one-half of patients went out of their HRR in 7 HSAs (11%) for radical prostatectomy, 3 HSAs (5%) for radical nephrectomy, 10 HSAs (15%) for PN, and 14 HSAs (22%) for RC. No HSAs had high export rates for TURP. Few patient factors were found to be associated with surgical care out of the HRR. High-export HSAs for PN and RC exhibited lower socioeconomic characteristics than low-export HSAs, adjusting for HSA population, race, and HSA procedure rates for PN and RC.
  
  
  CONCLUSIONS
  Patients living in areas with lower socioeconomic status have a greater need to travel for complex urologic surgery. Consideration of geographic delineation in the delivery of urologic oncology care may aid in regional quality improvement initiatives.
authors: Department of Urology, University of Washington, Seattle, Washington.
authors: Matthew
authors: M
authors: Mossanen
authors: Jason
authors: J
authors: Izard
authors: Jonathan L
authors: JL
authors: Wright
authors: Jonathan D
authors: JD
authors: Harper
authors: Michael P
authors: MP
authors: Porter
authors: Kenn B
authors: KB
authors: Daratha
authors: Sarah K
authors: SK
authors: Holt
authors: John L
authors: JL
authors: Gore
mesh_terms: D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D015653:Cystectomy / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000191:economics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011468:Prostatectomy / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data; D014481:United States; D014571:Urologic Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology
keywords: bladder carcinoma; health care disparities; kidney carcinoma; prostate carcinoma; quality of care