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
基本信息
- 批准号:9766399
- 负责人:
- 金额:$ 19.06万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AccountingAddressAdmission activityAffectAmerican Hospital AssociationBiological ModelsCaringCensusesCessation of lifeClinicalClinical DataComplexCritical CareDataDatabasesDemographic FactorsDevelopmentDisadvantagedDiseaseEmergency SituationEnsureEtiologyFutureGeographic DistributionGeographic FactorGeographic Information SystemsGeographic LocationsGeographyGoalsHealthHealth ServicesHealth Services AccessibilityHealth system plansHemorrhageHospitalizationHospitalsIncomeIndividualInfectionInpatientsInstitutionInsurance CoverageInterventionIntuitionLocationLow Income PopulationLow incomeMapsMeasuresMethodsMinorityModelingMorbidity - disease rateObstructionOperative Surgical ProceduresOutcomeOutcome MeasureOutcomes ResearchPatientsPerforationPlayPopulationPrimary Health CarePublic HealthRaceRegression AnalysisResearchResolutionResource AllocationResourcesRoleRuralServicesSeverity of illnessSourceSubgroupSystemSystems DevelopmentTechniquesTechnologyTestingTimeTraumaUninsuredUnited StatesVulnerable Populationsadministrative databasebasecare deliveryclinical databasecostdemographicsdisadvantaged populationexperiencegastrointestinalhigh riskimprovedinnovationinsightinterestmortalitynoveloncologyprogramspublic health emergencyrural disparitiessocialsociodemographicssocioeconomic disadvantagesurgery outcomesurgical researchsurgical risksurgical servicetool
项目摘要
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
期刊论文数量(2)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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:
- 影响因子:0
- 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:
- 影响因子:0
- 作者:McCrum ML;Wan N;Lizotte SL;Han J;Varghese T;Nirula R
- 通讯作者:Nirula R
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Marta L. McCrum其他文献
Impact of premorbid oral anticoagulant use on survival in patients with traumatic intracranial hemorrhage.
病前口服抗凝药的使用对创伤性颅内出血患者生存的影响。
- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:4.1
- 作者:
David Botros;Diwas Gautam;Forrest A Hamrick;Sarah Nguyen;Janet Cortez;Jason B Young;Sarah Lombardo;Marta L. McCrum;S. Menacho;R. Grandhi - 通讯作者:
R. Grandhi
Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry
年轻创伤患者基于体重的依诺肝素血栓预防:CLOTT-1 注册分析
- DOI:
- 发表时间:
2024 - 期刊:
- 影响因子:2
- 作者:
Sarah Lombardo;Marta L. McCrum;M. Knudson;Ernest E Moore;L. Kornblith;Scott Brakenridge;Brandon Bruns;M. Cipolle;Todd W. Costantini;Bruce Crookes;Elliott R. Haut;Andrew J. Kerwin;Laszlo N Kiraly;L. Knowlton;Matthew J. Martin;M. Mcnutt;David J. Milia;Alicia Mohr;Frederick Rogers;Thomas Scalea;S. Sixta;David Spain;Charles E Wade;G. Velmahos;Raminder Nirula;Jade M. Nunez - 通讯作者:
Jade M. Nunez
Excess Mortality after Emergency General Surgery Readmission at Non-Index Hospitals: Patient and System Contributors
- DOI:
10.1016/j.jamcollsurg.2019.08.336 - 发表时间:
2019-10-01 - 期刊:
- 影响因子:
- 作者:
Austin R. Cannon;Matthew R. Kingsbury;Chelsea M. Allen;Angela P. Presson;Lyen C. Huang;Marta L. McCrum - 通讯作者:
Marta L. McCrum
Impact of Insurance Expansion on Disposition for Pediatric Trauma Patients: A National Trauma Data Bank Cohort Study
- DOI:
10.1016/j.jss.2021.04.037 - 发表时间:
2021-11-01 - 期刊:
- 影响因子:
- 作者:
Liese C.C. Pruitt;Brian T. Bucher;Katie W. Russell;Marta L. McCrum - 通讯作者:
Marta L. McCrum
Marta L. McCrum的其他文献
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