Document Type


Date of Degree

Fall 2009

Degree Name

MS (Master of Science)

Degree In


First Advisor

Yang Xie


Volume has been suggested as a surrogate quality indicator for breast cancer surgeries by several researchers. It is crucial to understand the underlying reasons as to why there is a disparity in utilization of high volume hospitals. However, the studies that investigated the mechanism underlying the disparity in high volume hospital utilization are very limited.

The objectives of this study include: 1) examine the relationship between geographic differential distance and utilization of high volume hospitals; 2) investigate other demographic, socioeconomic and clinical factors that may affect patients' utilization of high volume hospitals. Multivariate logistic regressions were used to evaluate factors that impact patients' utilization of high volume hospitals.

The study results showed that geographic distance is a significant factor that impedes patients' utilization of high volume hospitals, independent of patients' clinical, demographic, and socioeconomic characteristics. It was also found that white, non-Hispanic women, patients with higher education level are more likely to be admitted in high volume hospitals compared to low volume hospitals. These factors are also significant to patients' choice of medium vs. low volume hospitals.

Geographic proximity is an important factor that affects patients' choice of hospital, and directing more patients to high volume hospitals should anticipate negative effects, such as increasing the cost of seeking care at high volume hospitals. Alternative strategies need to be developed to improve surgical outcomes without increasing patients' traveling related cost, such as enhancing the network between high volume hospitals and low volume hospitals, establishing radiation centers in rural areas.


vi, 62 pages


Includes bibliographical references (pages 56-62).


Copyright 2009 Yin Wan