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Local access to subspecialty care influences the chance of receiving a liver transplant.
MedLine Citation:
PMID:  23213024     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Prior studies have examined the impacts of demographic factors on liver transplant outcomes. These factors may be surrogate markers for access to medical care. We investigated physician density in referred patients' hospital service areas as a factor in patients' probability to receive a liver transplant. Methods: We performed a retrospective review of patients referred for liver transplantation from 2002 through 2010. Data on physician density was obtained from the Dartmouth Atlas. The primary outcome was receipt of a liver transplant. Cox Hazard Analysis was used to control for various demographic and medical covariates. Results: 1485 adult patients were considered for liver transplant over the time period. Factors that influenced the hazard of receiving a liver transplant were MELD score at referral [HR 1.11 (1.09 - 1.14) per point], secondary diagnosis of hepatocellular carcinoma [HR 2.76 (1.76 - 4.20)], blood group AB [OR 2.98 (1.52 - 5.87), referent A], the type of insurance [Medicare OR 0.36 (0.14 - 0.89); referent commercial insurance], and the number of gastroenterologists in a hospital service area [OR 1.12 (1.01 - 1.25) per increase in each gastroenterologist per 100,000 population]. Age, race, sex, distance to transplant center, or residence in a rural community did not influence the hazard to receive a liver transplant. Conclusions: The hazard of receiving a liver transplant is influenced by diagnosis, MELD, and insurance status; in addition patients were 12% more likely to receive a transplant for each unit increase in gastroenterologists per 100,000 population in their local hospital service area. Local access to gastroenterology subspecialty care is an important factor in receiving a liver transplant. © 2012 American Association for the Study of Liver Diseases.
Authors:
A Sidney Barritt; Stephen A Telloni; Clarence W Potter; David A Gerber; Paul H Hayashi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-5
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  -     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Association for the Study of Liver Diseases.
Affiliation:
University of North Carolina, Department of Medicine, Division of Gastroenterology and Hepatology. barritt@med.unc.edu.
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