domingo, 15 de abril de 2018

Disparities in access to emergency general surgery care in the United States. - PubMed - NCBI

Disparities in access to emergency general surgery care in the United States. - PubMed - NCBI



 2018 Feb;163(2):243-250. doi: 10.1016/j.surg.2017.07.026. Epub 2017 Oct 16.

Disparities in access to emergency general surgery care in the United States.

Abstract

BACKGROUND:

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities.

METHODS:

To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census.

RESULTS:

Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%).

CONCLUSION:

Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide.

PMID:
 
29050886
 
DOI:
 
10.1016/j.surg.2017.07.026

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