A. Diaz1, A. B. Haynes2,3 1Virginia Commonwealth University,Department Of Surgery,Richmond, VA, USA 2Massachusetts General Hospital,Department of Surgery,Boston, MA, USA 3Ariadne Labs,Boston, MA, USA
Introduction: Hospital service areas(HSA) were created in the 1990s to help identify local health care markets. Based on these HSAs, health professional shortage areas(HPSA) were developed to identify populations without access to primary care. No such metric exists for surgery. Furthermore, recent policy changes leading to financial constraints and closure of rural and critical access hospitals (CAH) have obscured local surgical care markets. HSAs have not been updated to reflect recent closures and changing markets. We propose an alternative method of defining surgical markets based on travel time.
Methods: We used publicly available datasets from Census.gov, Virginia Health Information, and the Virginia Geographic Information Network. We tabulated general surgeons, hospitals, and inpatient general surgery procedures per HSAs in Virginia using ESRI’s ArcGIS 10.3. Next, using the Network Analyst extension we created a network dataset of all roads with direction and speed limits in Virginia. We solved for the service area for acute care and critical access hospitals for various travel times. Service areas were then overlaid on the 2010 census population block file and the total population within each respective service area was tabulated.
Results: According to the 2010 census there were 8,001,024 people living in Virginia. There are 73 acute care hospitals and 7 CAHs. Of the 7 CAHs 3 do not perform any general surgery procedures and one performed only 2 procedures in 2014. These hospitals were excluded from the analysis. 700 physicians in the Virginia physician masterfile self identified as general surgeons. 9 of 23 HSAs were found to have fewer than 6 general surgeons per 100k residents; 1 of the 9 had fewer than 3 general surgeons per 100k residents. Hospitals per 100k residents ranged from 0.39 to 3.71 per HSA and inpatient general surgeries ranged from 58.22 to 923.71 per 100k residents. Based on the service area analysis, we found that 595,070 residents lived further than 30 minutes from any hospital providing general surgical services. When modeled for closure of critical access hospitals an additional 69,234 residents would have to drive 30 minutes or more to the next nearest hospital.
Conclusion: HPSAs based on HSAs have proven to be effective for primary care. Surgical service areas have been more elusive due to the added complexity of requiring a facility and staff to perform surgery. Furthermore, time may be of the essence in general surgery where an uncomplicated appendicitis or diverticulitis can become complicated in a matter of minutes to hours. A more accurate surgical service area might be reflected in metrics that take travel time into account.
