Trends in Timely Access to High-Quality and Affordable Surgical Care in the United States.

Autor:	Mullens CL; Department of Surgery, University of Michigan. Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI.; UM National Clinician Scholars Program. Ann Arbor, MI., Ibrahim AM; Department of Surgery, University of Michigan. Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI.; Taubman College of Architecture and Urban Planning, University of Michigan. Ann Arbor, MI., Clark NM; Department of Surgery, University of Washington. Seattle, WA., Kunnath N; Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI., Dieleman JL; Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA., Dimick JB; Department of Surgery, University of Michigan. Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI., Scott JW; Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI.; Department of Surgery, University of Washington. Seattle, WA.; Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1097/SLA.0000000000006586
Abstrakt:	Objective: To quantify recent trends in access to timely, high-quality, affordable surgical care in the US. Background: Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens. Methods: This observational cross-sectional study evaluates multiple domains of access to surgical care across the US from 2011-2015 and 2016-2020. Our stepwise model included timeliness (<60-minute drive time), quality (surgically capable hospital with ≥3 CMS stars), and affordability (neither uninsured nor underinsured) of access to surgical care using a novel combination of data from the American Hospital Association, Medicare claims, CMS's Five-Star Quality Rating System, the American Community Survey, and the Medical Expenditure Panel Survey. Results: The number of Americans lacking access to timely, high-quality, affordable surgical care increased from 97.7 million in 2010-2015 to 98.7 million in 2016-2020. Comparing these two periods, we found improvements in the number of Americans lacking access due to being uninsured (decrease from 38.5 to 26.5 million). However, these improvements were offset by increasing numbers of Americans for whom timeliness (increase from 9.5 to 14.1 million), quality (increase from 3.4 to 4.9 million), and underinsured status (increase from 46.3 to 53.1 million) increased as barriers to access. Multiple sensitivity analyses using alternative thresholds for each access domain demonstrated similar trends. Those with insufficient access to care tended to be more rural (6.7% vs. 2.0%, P<0.001), lower income (40.7% vs. 30.0%, P<0.001), and of Hispanic ethnicity (35.9% vs. 15.8%, P<0.001). Conclusions: Nearly one-in-three Americans lack access to surgical care that is timely, high-quality, and affordable. This study identifies the multiple actionable drivers of access to surgical care that notably can each be addressed with specific policy interventions. Competing Interests: Financial disclosures and funding: Dr. Dimick is a cofounder of ArborMetrix, Inc, a company that makes software for profiling hospital quality and efficiency. The authors have no conflicts of interest pertaining to the work herein. Dr. Ibrahim receives funding from the Agency for Healthcare Research and Quality (AHRQ) as principal investigator on grant R01-HS028606-01A1, from AHRQ as a co-investigator on grant R18-HS028963, and from the National Institutes of Health (NIH) as a co-principal investigator on grant R0-1DK137466. Dr. Scott receives funding from AHRQ as principal investigator on grant K08-HS028672 and from the NIH as a co-principal investigator on grant R0-1DK137466. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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