Understanding and Investigating Access to Surgical Care.
Understanding and Investigating Access to Surgical Care.
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了解和调查获得手术护理的机会。
DOI：
10.1097/sla.0000000000005212
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发表时间：
2022
影响因子：
9
通讯作者：
Weissman,JoelS
中科院分区：
文献类型：
--
作者：
Bergmark,ReganW;Burks,CierstenA;Schnipper,JeffreyL;Weissman,JoelS
获得高质量负担得起的医疗保健的差距是我们这个时代最大的挑战之一。1，2最佳可及性与护理质量密不可分，3而较差的可及性可导致患者发病率、死亡率和经济毒性过高。在这篇文章中，我们提出了我们的看法，获得手术治疗作为一个过程发生在一个连续的。4由于全面的纵向数据有限，而且调查过程中的步骤沿着往往没有记录，因此调查获得手术护理的机会可能具有挑战性。因此，我们描述的方法，可能有助于克服这些方法的挑战。获得是“及时使用个人卫生服务以实现最佳可能结果”和“满足卫生保健需求的机会”。2，5出于我们的目的，我们采用了医疗保健改善研究所的患者流概念，6并将手术入路定义为具有正确初始入路点的正确患者，在正确的时间和正确的手术团队在正确的环境中进行正确的检查和治疗（图1）。获得服务始于对需求的认识和与医疗保健系统的初步接触。接下来，一个关键但往往研究不足的步骤是，患者必须通过紧急医疗服务、转诊网络或自我转诊，与正确的外科医生和设施联系起来。这个过程的最后步骤包括手术治疗和干预、恢复和随访。我们承认，外科疾病在人口中分布不均，并受到卫生系统准入的影响。公共卫生和公共政策的研究可能有助于减少外科疾病。例如，对预防机动车碰撞7和枪支暴力8、9的研究，或对增加人类乳头瘤病毒疫苗接种以预防宫颈癌和口咽癌10的战略的研究，都可以预防外科疾病。外科医生应该帮助领导这些努力。然而，出于这项工作的目的，我们专注于从疾病识别开始的护理，因为这更完全地处于医疗保健系统的控制之下。
Disparities in access to high-quality affordable healthcare present one of the greatest challenges of our time. 1, 2 Optimal access is inextricably linked with quality of care, 3 and poor access can lead to excess patient morbidity, mortality, and financial toxicity. In this article, we present our view of access to surgical care as a process taking place over a continuum. 4 Investigating access to surgical care can be challenging due to limited comprehensive longitudinal data and the often undocumented steps along the way. Therefore, we describe approaches that may help overcome these methodological challenges. Access is ‘‘the timely use of personal health services to achieve the best possible outcome’’and the ‘‘opportunity to have health care needs fulfilled.’’2, 5 For our purposes, we adapted the Institute of Healthcare Improvement concept of patient flow, 6 and define surgical access as the right patient having the right initial access point, undergoing the right workup and treatment with the right surgical team in the right setting at the right time (Fig. 1). Access begins with a recognition of need and initial contact with the healthcare system. Next, a critical but often under-studied step is that the patient must be connected to the right surgeon and facility, via emergency medical services, referral networks, or self-referral. The final steps in this process include surgical work-up and intervention, recovery, and follow-up. We acknowledge that surgical disease is distributed unevenly across populations and is affected by health system access. Research in public health and public policy may help to reduce surgical disease. For example, research on the prevention of motor vehicle crashes 7 and gun violence, 8, 9 or on strategies to increase vaccination against human papillomavirus to prevent cervical and oropharyngeal cancer, 10 may prevent surgical disease. Surgeons should help lead these efforts. For the purposes of this work, however, we focus on care beginning at the point of disease recognition because this is more fully under the control of the healthcare system.