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.

项目概要/摘要 急诊普通外科 (EGS) 在美国构成了重大的公共卫生负担。和 每年约有 300 万人入院，此类高风险手术情况占所有情况的 50% 手术死亡率，尽管仅占手术入院人数的 11%。及时访问和呈现 能够快速进行手术干预的设施对于这些情况至关重要，因为护理的延误与此相关 随着发病率和死亡率的增加。先前的 EGS 研究已确定农村、少数民族、无保险和 社会经济弱势群体的晚期临床表现发生率较高，并且 EGS 结果更差，引发人们对获得紧急手术服务方面的差异的担忧。虽然它是 直觉上，获得护理的地理机会在 EGS 结果中发挥着作用，但尚不清楚其相互作用的程度 与上述社会人口因素有关，并导致了这些差异。 该提案的首要目标是了解 EGS 获取差异的原因。我们的中央 假设地理访问通过与社会、患者和患者的互动有助于 EGS 结果 疾病相关因素对弱势群体的影响尤为严重。我们将解决 这些假设通过以下具体目标：（1）我们将首先开发一个国家地理 量化 EGS 服务获取差异的信息系统。使用国家人口普查和医院数据， 我们将生成具有 EGS 能力的医院的交互式地图，并将其与关键分布进行分层 感兴趣的人群：农村、少数民族、无保险和低收入个人。然后我们将使用高级 空间建模技术来量化这些人群进入 EGS 医院的差异，以及 确定最需要增强手术能力的区域。 (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对 EGS 结果差异的影响。使用 混合效应回归模型，我们将评估改善地理访问会在多大程度上减少 观察到的弱势群体的结果差异。 所提出的研究代表了 GIS 技术在外科研究中的新颖应用。使用 地理空间建​​模将为地理访问和资源分配提供重要的见解 导致对时间敏感的 EGS 情况的手术差异。这种方法将进一步使我们能够 确定干预目标的特定区域和人群。最后，国家地理信息系统的发展 通过确保公平，平台有潜力为未来的 EGS 区域化和规划工作提供信息 为弱势群体分配服务。

项目成果

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.

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