Patient preferences for location of care - Implications for regionalization

BACKGROUND. Regionalization of high-risk surgical procedures to selected hi gh-volume centers has been proposed as a way to reduce operative mortality. For patients, however, travel to regional centers may be undesirable despi te the expected mortality benefit. OBJECTIVE. TO determine the strength of patient preferences for local care. DESIGN. Using a scenario of potentially resectable pancreatic cancer and a modification of the standard gamble utility assessment technique, we determ ined the level of additional operative mortality risk patients would accept to undergo surgery at a local rather than at a distant regional hospital i n which operative mortality was assumed to be 3%. We used multiple logistic regression to identify predictors of willingness to accept additional risk . SUBJECTS. One hundred consecutive patients (95% male, median age 65) awaiti ng elective surgery at the Veterans Affairs Medical Center in White River J et., VT. MAIN OUTCOME MEASURE. Additional operative mortality risk patients would ac cept to keep care local. RESULTS. All patients preferred local surgery if the operative mortality ri sk at the local hospital were the same as the regional hospital (3%). If lo cal operative mortality risk were 6%, which is twice the regional risk, 45 of 100 patients would still prefer local surgery. If local risk were 12%, 2 3 of 100 patients would prefer local surgery. If local risk were 18%, 18 of 100 patients would prefer local surgery. Further increases in local risk d id not result in large changes in the proportion of patients preferring loc al care. CONCLUSIONS. Many patients prefer to undergo surgery locally even when trav el to a regional center would result in lower operative mortality risk. The refore, policy makers should consider patient preferences when assessing th e expected value of regionalizing major surgery.