title: "Take the Volume Pledge" may result in disparity in access to care.
abstract: "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards.
  
  
  
  Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care.
  
  
  
  Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients.
  
  
  
  Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Blanco
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
authors.affiliation: Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL; Department of Urology, Loyola University Medical Center, Maywood, IL.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackwell
authors.affiliation: Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.affiliation: Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Yau
authors.affiliation: Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL; Department of Computer Science, DePaul University, Chicago, IL.
authors.forename: John P
authors.initials: JP
authors.lastname: Attisha
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ezure
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Sam
authors.initials: S
authors.lastname: Pappas
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, IL. Electronic address: gabood@lumc.edu.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
mesh_terms: D000368:Aged; D005260:Female; D005431:Florida; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012959:Socioeconomic Factors