|1R01CA244189-01A1 Interpret this number
|University Of Pittsburgh At Pittsburgh
|Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery
Cancer patients in rural areas have more limited access to specialized care, are less likely to receive certain
treatments, and have poorer outcomes than their counterparts in non-rural areas. Over recent years, many
rural hospitals have closed and a high proportion of remaining rural hospitals are in financial distress and at
risk for closure, exacerbating barriers to care for rural patients. At the same time, evidence that the volume of
surgeries performed in a hospital is associated with improved health outcomes, including mortality, has led to
efforts to regionalize surgical care. Although the advantages of regionalization are well documented, referring
cancer surgeries to high-volume centers presents challenges for patients, surgeons, and hospitals in rural
communities. Against this complex backdrop, the state of Pennsylvania has initiated the Pennsylvania Rural
Health Model (PRHM), an innovative program designed to provide hospitals with predictable revenue streams
through global budgets and encourage participating hospitals to redesign care delivery to best meet the needs
of their communities. This project will assess the impact of the PRHM on access to and outcomes associated
with cancer surgery. First, we will examine the impact of the PRHM on regional cancer surgery delivery
patterns by examining the location and characteristics of hospitals at which cancer patients receive surgery
using statewide hospital discharge data. By decoupling payment from volume, PRHM changes the incentives
for providers to perform surgeries locally versus referring patients to regional centers. We hypothesize that
patients in areas served by PRHM hospitals will be more likely to be referred to high-volume centers than
those in other rural hospital markets. Second, we will assess the effect of the PRHM on cancer surgery access
and outcomes using linked discharge and cancer registry data. The PRHM emphasizes changes in care
delivery that target improvements in population health, with a focus on access to specialty care. We
hypothesize that surgical cancer patients in areas served by PRHM hospitals may experience improvements in
receipt of recommended cancer surgery, time to surgery, and related health outcomes, including mortality and
readmissions. Third, we will use qualitative methods to understand the PA Rural Health Model implementation
process, including its impacts on resource utilization, hospital capabilities, staffing, care delivery, and financial
incentives for providers. We will conduct interviews with key informants and focus groups with community
stakeholders. Guided by a comprehensive conceptual model derived from implementation science, we will
granularly assess the mechanisms by which PRHM succeeded or failed to affect hospital processes and
outcomes for surgical cancer care. As the population in areas served by targeted hospitals continues to age,
cancer incidence and the demand for high-quality surgical care will increase. Lessons from this context will be
highly relevant for informing alternative payment models in rural hospitals and addressing the needs of surgical
cancer patients in rural communities throughout the United States.
Early impacts of the Pennsylvania Rural Health Model on potentially avoidable utilization.
, Roberts E.T.
, Sabik L.M.
Health affairs scholar, 2024 Feb; 2(2), p. qxae002.
Urban-Rural Differences in Receipt of Cancer Surgery at High-Volume Hospitals and Sensitivity to Hospital Volume Thresholds.
, Sun Z.
, Yabes J.
, Jacobs B.
, Sabik L.M.
JCO oncology practice, 2024 Jan; 20(1), p. 123-130.