*Department of Economic, Lehigh University, Bethlehem, PA †National Bureau of Economic Research, Cambridge, MA ‡Department of Health Policy, School of Public Health and Health Services, The George Washington University, Washington, DC.
Med Care. 2014 Mar;52(3):250-7. doi: 10.1097/MLR.0000000000000082.
Changes in the location and availability of surgical services change the distances that patients must travel for surgery. Identifying health effects related to travel distance is therefore crucial to evaluating policies that affect the geographic distribution of these services. We examine the health outcomes of coronary artery bypass graft (CABG) patients in Pennsylvania for evidence that traveling further to a hospital for a one-time, scheduled surgical procedure causes harm.
We perform instrumental-variable regressions to test for the effect of distance to the admitting hospital on the in-hospital mortality and readmission rates of 102,858 CABG patients in Pennsylvania during 1995-2005, where the instrumental variables are constructed based on the quality of and distance to nearby CABG hospitals.
We found that patients living near a CABG hospital with acceptable quality traveled significantly less and if they were high-risk, had lower in-hospital mortality rates. Readmission rates in general are not affected by patients' travel distance.
The positive correlation between travel distance and health outcomes observed by previous studies may reflect the confounding effects of behavioral factors and patient health risks. We found instead that living further from the admitting hospital increases in-hospital mortality for high-risk CABG patients. More research on the possible causes of these effects is necessary to identify optimal policy responses.
手术服务地点和可及性的变化改变了患者进行手术的旅行距离。因此，确定与旅行距离相关的健康影响对于评估影响这些服务地理分布的政策至关重要。我们研究了宾夕法尼亚州冠状动脉旁路移植术（CABG）患者的健康结果，以证明患者前往医院进行一次性计划手术的距离更远会造成伤害。
我们进行了工具变量回归，以检验距离入院医院的距离对 1995-2005 年宾夕法尼亚州 102858 例 CABG 患者的住院死亡率和再入院率的影响，其中工具变量是基于附近 CABG 医院的质量和距离构建的。
我们发现，居住在附近质量可接受的 CABG 医院的患者旅行距离明显较短，如果是高危患者，住院死亡率较低。一般来说，再入院率不受患者旅行距离的影响。
先前研究中观察到的旅行距离与健康结果之间的正相关关系可能反映了行为因素和患者健康风险的混杂影响。相反，我们发现，对于高危 CABG 患者来说，距离入院医院越远，住院死亡率越高。需要进一步研究这些影响的可能原因，以确定最佳政策应对措施。
