Disparities in access to emergency general surgery care in the United States
Disparities in access to emergency general surgery care in the United States
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DOI：
10.1016/j.surg.2017.07.026
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发表时间：
2018-02-01
期刊：
影响因子：
3.8
通讯作者：
Santry, Heena P.
中科院分区：
文献类型：
--
作者：
Khubchandani, Jasmine A.;Shen, Connie;Santry, Heena P.
背景。随着接听紧急普通外科电话的外科医生越来越少，医院也减少了紧急服务，美国正面临医疗危机。我们检查了国家急诊普外科能力和县级获得急诊普外科护理的决定因素，特别关注差异。方法。为了确定潜在的急诊普通外科医院，我们在美国医院协会的数据库中查询了“急症护理综合医院”，其中包含“外科服务”、“急诊科”和“手术室”。互联网搜索和直接联系证实了急诊普通外科服务每周 7 天、每天 24 小时覆盖急诊室。地理和人口层面的紧急普通外科手术访问权限来自地理信息系统和美国人口普查结果。 2013年美国医院协会数据库中的6,356家医院中，只有2,811家是急诊普外科医院。黑人、西班牙裔、无保险和低教育人口比例较高的县以及农村县不成比例地缺乏获得紧急普通外科护理的机会。例如，与非裔美国人人口 25% 以下的县 (0.6%) 相比，非裔美国人人口 75% 以上的县 (10.2%) 没有急诊普外科医院的可能性 > 80%。结论。美国各地在获得急诊普通外科服务方面存在差距，这对服务不足的农村社区造成了不成比例的影响。政策举措需要提高全国范围内的急诊普外科能力。 (C) 2017 Elsevier Inc. 保留所有权利。
Background. As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities.Methods. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census.Results. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%).Conclusion. Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. (C) 2017 Elsevier Inc. All rights reserved.