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

项目总结/摘要 在美国，急诊普通外科（EGS）是一个重大的公共卫生负担。与 每年约有300万例入院，这部分高危手术病例占所有病例的50%。 手术死亡率，尽管仅占手术入院的11%。及时获取和提交 能够快速手术干预的设施对这些疾病至关重要，因为护理延迟与 发病率和死亡率增加。以前的EGS研究已经确定了农村，少数民族，无保险和 社会经济弱势人群的晚期临床表现率较高， EGS结果更差，引起了人们对获得紧急手术服务的不平等的关注。虽然 直觉上，地理上获得护理的机会在EGS结果中起作用，但尚不清楚它在多大程度上相互作用 上述社会人口因素的影响，并促成了这些差距。 该提案的总体目标是了解环境商品和服务获取不平等的根源。我们的中央 假设是地理通道通过与社会、患者和 与疾病有关的因素对脆弱人口的影响尤为严重。我们将解决 这些假设通过以下具体目标：（1）我们将首先制定一个国家地理 信息系统，以量化在获得环境商品和服务方面的差距。利用全国人口普查和医院数据， 我们将生成一个交互式地图的电子政务能力的医院，并分层与分布的关键 感兴趣的人群：农村、少数民族、无保险和低收入个人。我们将使用先进的 空间建模技术，以量化这些人群在获得EGS医院方面的差异， 确定最需要加强外科能力的地区。(2)随后，我们将联合收割机的临床数据 空间模型，以确定在EGS结果的差异的地理访问的贡献。使用 混合效应回归模型，我们将评估在多大程度上改善地理通道将减少 观察到的弱势群体的结果差异。 该研究代表了GIS技术在外科研究中的新应用。使用 地理空间建模将提供重要的洞察力，以了解地理通道和资源分布 导致对时间敏感的EGS条件的手术差异。这种方法将进一步使我们能够 确定干预的具体区域和人群。最后，开发国家地理信息系统 该平台有可能通过确保公平、公正的环境和商品服务，为未来的环境和商品服务区域化和规划工作提供信息 为弱势群体提供服务。

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.