A Geographic Information System to Evaluate Disparities in Access to Emergency Surgery Services

用于评估获得紧急手术服务差异的地理信息系统

• 批准号: 9766399
• 负责人: Marta L. McCrum
• 金额: $ 19.06万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-17 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766399
• 关键词: Accounting; Address; Admission activity; Affect; American Hospital Association; Biological Models; Caring; Censuses; Cessation of life; Clinical; Clinical Data; Complex; Critical Care; Data; Databases; Demographic Factors; Development; Disadvantaged; Disease; Emergency Situation; Ensure; Etiology; Future; Geographic Distribution; Geographic Factor; Geographic Information Systems; Geographic Locations; Geography; Goals; Health; Health Services; Health Services Accessibility; Health system plans; Hemorrhage; Hospitalization; Hospitals; Income; Individual; Infection; Inpatients; Institution; Insurance Coverage; Intervention; Intuition; Location; Low Income Population; Low income; Maps; Measures; Methods; Minority; Modeling; Morbidity - disease rate; Obstruction; Operative Surgical Procedures; Outcome; Outcome Measure; Outcomes Research; Patients; Perforation; Play; Population; Primary Health Care; Public Health; Race; Regression Analysis; Research; Resolution; Resource Allocation; Resources; Role; Rural; Services; Severity of illness; Source; Subgroup; System; Systems Development; Techniques; Technology; Testing; Time; Trauma; Uninsured; United States; Vulnerable Populations; administrative database; base; care delivery; clinical database; cost; demographics; disadvantaged population; experience; gastrointestinal; high risk; improved; innovation; insight; interest; mortality; novel; oncology; programs; public health emergency; rural disparities; social; sociodemographics; socioeconomic disadvantage; surgery outcome; surgical research; surgical risk; surgical service; tool

PROJECT SUMMARY/ABSTRACT Emergency General Surgery (EGS) constitutes a significant public health burden in the United States. With approximately 3 million admissions a year, this subset of high-risk surgical conditions accounts for 50% of all surgical mortality, despite representing only 11% of surgical admissions. Timely access and presentation to facilities capable of rapid surgical intervention is critical for these conditions, as delays in care are associated with increased morbidity and mortality. Previous research in EGS has identified rural, minority, uninsured and socioeconomically disadvantaged populations as having higher rates of advanced clinical presentation and worse EGS outcomes, raising concerns for disparities in access to emergency surgical services. While it is intuitive that geographic access to care plays a role in EGS outcomes, it is unclear to what degree it interacts with the above socio-demographic factors and contributes to these disparities. The overarching goal of this proposal is to understand the etiology of disparities in access to EGS. Our central hypothesis is that geographic access contributes to EGS outcomes through interactions with social, patient and disease-related factors in a manner which disproportionately affects vulnerable populations. We will address these hypotheses through the following Specific Aims: (1) We will first develop a national geographic information system to quantify disparities in access to EGS services. Using national census and hospital data, we will generate an interactive map of EGS-capable hospitals, and layer this with distributions of key populations of interest: rural, minority, uninsured and low-income individuals. We will then use advanced spatial modelling techniques to quantify disparities in access to EGS hospitals for these populations and identify regions in greatest need of enhanced surgical capacity. (2) Subsequently, we will combine clinical data with spatial models to determine the contribution of geographic access to disparities in EGS outcomes. Using mixed-effects regression modelling, we will evaluate to what extent improving geographic access would reduce the observed outcome disparities for vulnerable populations. The proposed research represents a novel application of GIS technology to surgical research. The use of geospatial modelling will provide important insight into how geographic access and resource distribution contribute to surgical disparities for time-sensitive EGS conditions. This approach will further enable us to identify specific regions and populations to target for intervention. Finally, the development of a national GIS platform holds potential to inform future EGS regionalization and planning efforts by ensuring equitable distribution of services for vulnerable populations.

项目总结/文摘

项目成果

Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California.

• DOI: 10.1097/ta.0000000000003087
• 发表时间: 2021-05-01
• 期刊: The journal of trauma and acute care surgery
• 作者: McCrum ML;Wan N;Lizotte SL;Han J;Varghese T;Nirula R
• 通讯作者: Nirula R

Disparities in Spatial Access to Emergency Surgical Services in the US.

• DOI: 10.1001/jamahealthforum.2022.3633
• 发表时间: 2022-10-07
• 期刊: JAMA HEALTH FORUM
• 作者: McCrum, Marta L.;Wan, Neng;Han, Jiuying;Lizotte, Steven L.;Horns, Joshua J.
• 通讯作者: Horns, Joshua J.