title: The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty.
abstract: Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling. The complication risk was higher (Odds Ratio 1.18 [95% CI: 1.16, 1.20]) if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks. However, patients from vulnerable groups were less likely to utilize these patterns.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Hassan M K
authors.initials: HM
authors.lastname: Ghomrawi
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Ting Jung
authors.initials: TJ
authors.lastname: Pan
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: health care disparities; health policy; regionalization; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty