University of California-Los Angeles, 1000 Veteran Avenue, Los Angeles, CA 90095-1670, USA.
Arthritis Care Res (Hoboken). 2012 Jun;64(6):890-7. doi: 10.1002/acr.21611. Epub 2012 Jan 11.
To examine the potential impact of a policy of selective referral to high-volume knee replacement hospitals on patients' travel distance to hospitals and access to care for patients seeking total knee replacement (TKR) in urban and rural settings.
The travel distance required for patients to reach their hospital of service and the additional travel distance required to reach the nearest high-volume hospital were analyzed using a 100% sample of Medicare fee-for-service patients undergoing TKR in 2001.
Of the 183,174 TKRs performed in the US during 2001, 95% of the patients selected underwent TKR at a hospital that was located within 50 miles of their residence. There were 11,550 patients who had their TKR performed at a low-volume hospital (LVH) where there was no nearer high-volume hospital. The impact of a policy that would direct patients to high-volume hospitals varied by region. In urban areas, the nearest high-volume hospital was a median of 3.8 miles further than the LVH of service. The patient factors race and poverty were associated with selection of LVHs in urban areas. In rural areas and urban clusters, 1,506 patients would have had to travel >50 miles and 259 patients would have had to travel >100 miles to reach a high-volume hospital.
A policy to direct patients away from LVHs could increase patients' travel time to hospitals in rural areas and restrict access for minority and low-income patients in urban areas. Any implementation of selective referral to high-volume centers should address access to hospitals for rural patients and urban minority and low-income patients.
研究将患者选择性转诊到高容量膝关节置换医院的政策对城市和农村地区寻求全膝关节置换（TKR）患者的医院就诊距离和获得医疗服务的潜在影响。
使用 2001 年 Medicare 按服务收费患者中 TKR 的 100%样本，分析患者到达服务医院所需的旅行距离以及到达最近高容量医院所需的额外旅行距离。
在 2001 年美国进行的 183174 例 TKR 中，95%的患者选择在距离其居住地 50 英里范围内的医院进行 TKR。有 11550 名患者在低容量医院（LVH）接受 TKR，而附近没有更高容量的医院。将患者转诊至高容量医院的政策的影响因地区而异。在城市地区，最近的高容量医院比服务的 LVH 中位数远 3.8 英里。患者因素种族和贫困与城市地区选择 LVH 有关。在农村地区和城市集群中，1506 名患者将不得不行驶>50 英里，259 名患者将不得不行驶>100 英里才能到达高容量医院。
将患者从 LVH 引导至高容量医院的政策可能会增加农村地区患者前往医院的旅行时间，并限制城市地区少数民族和低收入患者的就诊机会。任何选择性转诊到高容量中心的实施都应解决农村患者和城市少数民族和低收入患者的医院就诊问题。
