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.

项目摘要/摘要 紧急通用手术（例如）在美国构成了巨大的公共卫生负担。和 每年大约有300万次入院，这部分高风险手术状况占所有的50％ 手术死亡率，尽管仅占手术入院的11％。及时访问和介绍 能够快速手术干预的设施对于这些情况至关重要，因为延迟与 随着发病率和死亡率的增加。 EGS的先前研究已经确定了农村，少数，没有保险和 在社会经济上处于不利地位的人群，其高级临床表现率较高，并且 更糟糕的是，例如，对获得紧急手术服务的差异引起了人们的担忧。虽然是 直观的地理访问获得护理在EGS的结果中起作用，目前尚不清楚它在多大程度上相互作用 有了上述社会人口统计学因素，并导致了这些差异。 该提案的总体目标是了解访问EGS的差异的病因。我们的中心 假设是，地理访问通过与社会，患者和患者的互动来促进EG的结果 与疾病相关的因素，以不成比例地影响脆弱人群。我们将解决 这些假设通过以下特定目的：（1）我们将首先开发一个国家地理 量化访问EGS服务的差异的信息系统。使用国家人口普查和医院数据， 我们将生成一张具有EGS能力医院的交互式图，并将其与密钥的分布分层 感兴趣的人群：农村，少数，没有保险和低收入个人。然后我们将使用高级 空间建模技术以量化这些人群和EGS医院的差异 确定最需要增强手术能力的地区。 （2）随后，我们将结合临床数据 使用空间模型来确定地理访问EGS结果中差异的贡献。使用 混合效应回归建模，我们将评估地理访问的程度在多大程度上减少 观察到的脆弱人群的结果差异。 拟议的研究代表了GIS技术在外科研究中的新应用。使用 地理空间建​​模将提供有关地理访问和资源分配的重要见解 有助于时间敏感的EGS条件的手术差异。这种方法将进一步使我们能够 确定特定区域和人群以进行干预。最后，国家GIS的发展 平台具有通过确保公平来告知未来EGS区域化和计划工作的潜力 为弱势群体的服务分配。

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.