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Regionalization of stem cell transplant procedures into teaching hospitals in United States: are we ready?

Bone Marrow Transplantation volume 51, pages 1004–1006 (2016)Cite this article

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Regionalization is a process wherein complex high-risk surgical procedures are selectively referred to be performed in selectively high volume, specialized, teaching hospitals. In the recent past, there has been increasing regionalization or concentration of a wide array of complex surgical procedures into high volume or teaching hospitals, the underlying empirical basis being that performing high-risk complex surgical procedures in large hospitals will lead to better outcomes.1, 2, 3, 4, 5 There is an increasing number of stem cell transplantation (SCT) procedures performed in the United States.6, 7 So far, there are no data on regionalization of SCTs into teaching hospitals. The specific aim of the present study is to examine if performance of SCT procedures has been regionalized to teaching hospitals over a 7-year-period from 2004 to 2010. The present study tests the hypothesis that during the latter years of the study period, more SCT procedures were performed in teaching hospitals as opposed to in non-teaching hospitals. A secondary aim is to examine if there is geographic variations in regionalization.

The Nationwide Inpatient Sample (NIS) for the years 2004–2010 was used. The NIS is the largest all-payer hospitalization database in the United States.8 NIS is sponsored by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ). A data user agreement was completed with HCUP–AHRQ before obtaining the data. The present study was granted Institutional Review Board Exempt status as a large publicly available database was used.

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References

  1. Allareddy V . Is there an increasing regionalization of surgical repair of craniosynostosis procedures into teaching hospitals? implications of regionalization. Cleft Palate Craniofac J 2016; 53: 197–202.

    Article  Google Scholar 

  2. Allareddy V, Ackerman MB, Venugopalan SR, Yadav S, Nanda VS, Nanda R . Longitudinal trends in discharge patterns of orthognathic surgeries: is there a regionalization of procedures in teaching hospitals? Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115: 583–588.

    Article  Google Scholar 

  3. Bhattacharyya N, Abemayor E . Combined changing patterns of hospital utilization for head and neck cancer care: implications for future care. JAMA Otolaryngol Head Neck Surg 2013; 139: 1043–1047.

    Article  Google Scholar 

  4. Cooperberg MR, Modak S, Konety BR . Trends in regionalization of inpatient care for urological malignancies, 1988 to 2002. J Urol 2007; 178: 2103–2108 (discussion 2108).

    Article  Google Scholar 

  5. Losina E, Kessler CL, Wright EA, Creel AH, Barrett JA, Fossel AH et al. Geographic diversity of low-volume hospitals in total knee replacement: implications for regionalization policies. Med Care 2006; 44: 637–645.

    Article  Google Scholar 

  6. Majhail N. CIBMTR slides and reports. http://www.cibmtr.org/ReferenceCenter/SlidesReports/Documents/CIBMTR_Center_Survey_Report.pdf.

  7. Allareddy V, Roy A, Rampa S, Lee MK, Nalliah RP, Allareddy V et al. Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States. Bone Marrow Transplant 2014; 49: 1278–1286.

    Article  CAS  Google Scholar 

  8. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2004 - 2010. Agency for Healthcare Research and Quality: Rockville, MD, USA. Available at http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 4 January 2014.

  9. Centers for Disease Control and Prevention. Classification of diseases, functioning, and disability. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Available at www.cdc.gov/nchs/icd/icd9cm.htm#ftp. Accessed 03 June 2014.

  10. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL . Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349: 2117–2127.

    Article  CAS  Google Scholar 

  11. Luft HS . The relation between surgical volume and mortality: an exploration of causal factors and alternative models. Med Care 1980; 18: 940–959.

    Article  CAS  Google Scholar 

  12. Menke TJ, Wray NP . When does regionalization of expensive medical care save money? Health Serv Manage Res 2001; 14: 116–124.

    Article  CAS  Google Scholar 

  13. Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC . Regionalization of high-risk surgery and implications for patient travel times. JAMA 2003; 290: 2703–2708.

    Article  CAS  Google Scholar 

  14. Kansagra SM, Curtis LH, Schulman KA . Regionalization of percutaneous transluminal coronary angioplasty and implications for patient travel distance. JAMA 2004; 292: 1717–1723.

    Article  CAS  Google Scholar 

  15. McGuirk MA, Porell FW . Spatial patterns of hospital utilization: the impact of distance and time. Inquiry 1984; 21: 84–95.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City, IA, USA

    V Allareddy

  2. Department of Health Management and Policy, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    S Rampa

  3. Division of Pediatric Critical Care, Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    N Martinez-Schlurmann & V Allareddy

  4. University of Michigan, Ann Arbor, MI, USA

    R P Nalliah

  5. Pediatric Cardiology, Boston Children’s Hospital, Harvard University, Boston, MA, USA

    V Allareddy

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  1. V Allareddy
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  2. S Rampa
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  3. N Martinez-Schlurmann
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  4. R P Nalliah
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  5. V Allareddy
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Correspondence to V Allareddy or V Allareddy.

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Allareddy, V., Rampa, S., Martinez-Schlurmann, N. et al. Regionalization of stem cell transplant procedures into teaching hospitals in United States: are we ready?. Bone Marrow Transplant 51, 1004–1006 (2016). https://doi.org/10.1038/bmt.2016.33

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