Family Preferences in the Volume Verse Outcome Debate: Implications for the Delivery of Complex Pediatric Care.

PIH64 FamIly PreFerences In tHe Volume Versus outcome Debate: ImPlIcatIons For tHe DelIVery oF comPlex PeDIatrIc care O’Leary G.1, Lockhart A.1, Mullenger R.2, Warren A.2, Hancock Friesen C.2, Levy A.2, Molinari M.2, O’Blenes S.2 1IWK Health Centre, Halifax, NS, Canada, 2Dalhousie University, Halifax, NS, Canada Objectives: A Relationship between volume and outcome for complex medical procedures has been used as an argument for regionalization; however, this must be balanced against preferences to have care delivered close to home. The objective of our study was to determine how families trade-off variations in risk against the ability to have complex pediatric care delivered locally. MethOds: Twenty parents of children without serious medical problems seen in an outpatient clinic participated in a probability trade-off experiment involving two scenarios in which they were asked to imagine their child required a complex medical procedure (‘lowrisk’= 5% mortality, ‘high-risk’= 30% mortality) available locally or at an alternate large center 2.5 hours away by air. Numeric and graphic representations of mortality risk were reduced in a stepwise fashion for procedures performed at the alternate center. Thresholds at which participants chose to travel were identified. Participant’s decisions were then challenged by increasing the costs incurred by travelling to the alternate center. Results: In the low-risk scenario, participants chose not to travel until absolute risk was reduced by 2±0.2% (relative risk reduction of 39±3%). In the high-risk scenario, a larger absolute risk reduction (5.1±0.8%, p= 0.0001) but smaller relative risk reduction (17±3%, p= 0.0001) triggered a decision to travel. In the low-risk scenario, only 2 of 8 participants with household income > $100,000/ yr changed their decision to travel when faced with additional costs; however 8 of 12 with lower income changed their decision (p= 0.07). In the high-risk scenario, 1 of 8 in the high income group changed their decision compared to 7 of 12 in the low income group (p= 0.04). cOnclusiOns: Many families would trade substantially higher risk to have complex pediatric care delivered locally. These results have implications for policy development related to delivery of complex care at smaller children’s hospitals located far from large urban centers.