title: The Relationship between Centralization of Care and Geographic Barriers to Cystectomy for Bladder Cancer.
abstract: Background:Centralization of cystectomy treatment for bladder cancer, while associated with improved outcomes, may impose geographic barriers to care. However, whether this effect may be counterbalanced by an increased number of high volume centers has not previously been explored.Objective:To characterize changes in geographic disparities to high volume cystectomy centers over time.Methods:Data on all inpatient admissions for cystectomy in New York State (NYS) from 1997-2011 was obtained from the Department of Health. Using these data, we classified hospitals according to cystectomy volume and measured patient distance traveled to a cystectomy center. Population weights, from the US Census, were used to describe changes in minimum travel distance to high- or very high-volume (HV/VHV) facilities across the NYS population.Results:Bladder cancer patients underwent cystectomies at 195 hospitals during the study period. In 1997-2001, eleven HV/VHV facilities accounted for 37.5% of all cystectomies, while sixteen HV/VHV hospitals accounted for 71.5% of all procedures during 2007-2011. Median distance traveled by cystectomy patients to all hospitals increased from 9.6 to 14.4 miles in 1997-2001 to 2007-2011, respectively. In the same time span, the median travel distance for the NYS population to a HV/VHV center decreased by 1.9 and 9.4 miles at the median and 75th percentile, respectively.Conclusions:Our findings demonstrate a complicated relationship between centralization and geographic access. While centralization has led to a decrease in overall access to cystectomy facilities, the process simultaneously improved access to high volume centers.
authors: Icahn School of Medicine at Mount Sinai , New York, NY, USA.
authors: Martin F
authors: MF
authors: Casey
authors: Department of Medicine, Divisions of General Internal Medicine and Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai , New York, NY, USA.
authors: Juan
authors: J
authors: Wisnivesky
authors: Icahn School of Medicine at Mount Sinai , New York, NY, USA.
authors: Valerie H
authors: VH
authors: Le
authors: Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai , New York, NY, USA.
authors: Umut
authors: U
authors: Sarpel
authors: Department of Urology, Lahey Hospital and Medical Center , Burlington, MA, USA.
authors: Kristian D
authors: KD
authors: Stensland
authors: Division of Hematology and Medical Oncology, The Tisch Cancer Institute , Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: William K
authors: WK
authors: Oh
authors: Division of Hematology and Medical Oncology, The Tisch Cancer Institute , Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Matthew D
authors: MD
authors: Galsky
keywords: Cystectomy; centralized hospital services; health services accessibility; healthcare disparities; urinary bladder neoplasms