Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures
Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures
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DOI：
10.1001/jamasurg.2016.1239
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发表时间：
2016-08-01
期刊：
影响因子：
16.9
通讯作者：
Mock, Charles
中科院分区：
文献类型：
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作者：
Stewart, Barclay T.;Tansley, Gavin;Mock, Charles
可以通过手术治疗的疾病占全球疾病负担的16%以上。然而，有50亿人无法获得基本的外科护理。在低收入和中等收入国家，通过提供及时和安全的手术，估计可以避免手术条件引起的8700万残疾调整生命年中的90%。加纳人口层面的基本外科手术的空间可及性尚不清楚。（即开放性骨折修复、紧急剖腹手术和剖腹产）作为更广泛地进行基本手术的代表，以绘制人口层面基本手术的空间获取情况，并确定最能改善基本手术获取情况的一级转诊医院如果在加纳得到加强，将最能改善基本手术的获取情况。设计背景和参与者：在加纳所有家庭和公立及私立非营利性医院中进行的基于人群的研究。家庭由地理参照普查数据代表。包括卫生部管理的一级和二级转诊医院以及所有三级医院。从2014年1月1日至12月31日收集手术数据。主要结果和测量2014年在加纳一级转诊医院进行的所有手术均用于将每个机构分为以下3个医院组之一：那些没有能力进行所有3种先导手术的患者，那些进行了1 - 11种手术的患者，以及每种手术至少进行12次的患者。候选人有针对性的能力提高成本距离和网络analysis.Results的155个一级转诊医院管理的加纳卫生服务和加纳基督教卫生协会，123（79.4%）报告手术数据。2014年，95例（77.2%）患者没有能力进行所有3种先导手术，24例（19.5%）患者进行了1 - 11种先导手术，4例（3.3%）患者进行了至少12种先导手术。有能力进行必要手术的一级转诊医院的必要手术率高于无能力的医院（中位数，638;四分位数范围，440-1418 vs 360;四分位数范围，每10万人0-896例手术; P = 0.03）。在2小时内对进行1 - 11次和至少12次每种领头羊手术的医院进行人群水平空间访问的比例分别为83.2%（不确定区间[UI]，82.2%-83.4%）和71.4%（UI，64.4%-75.0%）。五家医院被确定为有针对性的能力improvement.CONCLUSIONS和相关性几乎30%的加纳人不能在2小时内获得必要的手术。领头羊能力是一个有用的指标，基本手术更广泛。类似的战略规划工作可能对其他低收入和中等收入国家有用，旨在改善获得基本手术的机会。
IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known.OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana.DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014.MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis.RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure-capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440-1418 vs 360; interquartile range, 0-896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2%(uncertainty interval [UI], 82.2%-83.4%) and 71.4%(UI, 64.4%-75.0%), respectively. Five hospitals were identified for targeted capability improvement.CONCLUSIONS AND RELEVANCE Almost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.