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

项目摘要/摘要 在美国，紧急普通外科手术(EGS)构成了重大的公共卫生负担。使用 每年大约有300万人入院，这类高危手术疾病占所有手术病例的50% 手术死亡率，尽管只占手术入院人数的11%。及时访问和展示 能够快速手术干预的设施对这些情况至关重要，因为护理的延误与 随着发病率和死亡率的增加。EGS之前的研究发现，农村、少数民族、没有保险和 社会经济上处于不利地位的人群具有较高的晚期临床表现和 更糟糕的EGS结果，引起了人们对获得紧急外科服务方面的差距的关注。虽然它是 直觉地认为，地理位置对EGS结果有影响，但目前还不清楚它在多大程度上相互作用 这与上述社会人口因素有关，并导致了这些差距。 这项提案的首要目标是了解在获得环境保护方面存在差异的原因。我们的中央 假说是，地理位置通过与社会、患者和 与疾病有关的因素，对弱势群体造成不成比例的影响。我们将解决 这些假设通过以下具体目标：(1)我们将首先制定一个国家地理 信息系统，以量化获得EGS服务方面的差距。利用全国人口普查和医院数据， 我们将生成支持EGS的医院的交互式地图，并使用密钥分发对其进行分层 关注人群：农村、少数民族、未参保和低收入个人。然后我们将使用高级 空间建模技术，以量化这些人群在获得EGS医院方面的差异 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准入对环境影响结果差异的贡献。vbl.使用 混合效应回归模型，我们将评估改善地理准入将在多大程度上减少 观察到的弱势人群的结果差异。 这项研究代表了地理信息系统技术在外科研究中的一种新应用。对.的使用 地理空间建模将提供有关地理访问和资源分布的重要见解 对于时间敏感的EGS情况，会造成手术差异。这种方法将进一步使我们能够 确定特定地区和人群作为干预目标。最后，国家地理信息系统的开发 平台有可能为未来的EGS区域化和规划工作提供信息，确保公平 为弱势群体分配服务。

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.