较低的社会经济地位预示着更大的护理障碍:使用门诊胆囊切除术作为模型队列
Michelle Y McGee1, Haroon M Janjua1, Meagan D Read1
1Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
The American surgeon
|June 15, 2024
概括
来自较低社会经济地位 (SES) 的困难社区的患者使用较低评级的医院,并前往更远的地方进行手术,特别是在农村地区. 这突显了与社区困境和位置相关的医疗保健获取差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康的社会经济决定因素
- 外科手术的结果
背景情况:
- 低社会经济地位 (SES) 的患者在获得医疗保健方面面临重大障碍.
- 困难社区指数 (DCI) 提供了一种评估社区社会经济福祉的新指标.
- 了解DCI对医疗保健利用的影响对于解决健康差异至关重要.
研究的目的:
- 评估困难社区指数 (DCI) 对门诊胆囊切除术的医院选择和旅行距离的影响.
- 根据社会经济地位和地理位置,确定影响患者进行手术的旅行距离的因素.
主要方法:
- 对佛罗里达州门诊胆囊切除术 (2016-2019) 数据库的分析.
- 患者DCI与医院评级,并发症 (查尔森并发症指数) 和旅行距离的比较.
- 循序渐进的物流回归来确定旅行距离的预测因素.
主要成果:
- 基于DCI的手术方法 (开放式,腹腔镜,机器人) 没有显著差异.
- 农村患者旅行的距离远远 (平均21.29英里) 比城市患者 (平均5.84英里).
- 来自受困DCI地区的患者更频繁地选择较低评级 (1-2星) 的医院 (61%),而不是繁荣地区 (36.3%).
- DCI预测农村患者的旅行量增加,而较高的医院评级预测城市患者的旅行量增加.
结论:
- 来自困难社区的患者,特别是农村地区的患者,在较低评级的设施中接受手术,并旅行更远的距离.
- 贫困农村地区医疗保健资源的可用性可能解释了旅行的增加.
- 来自困境地区的郊区患者减少旅行可能反映了个人资源的限制.
- 研究结果强调了社会经济因素,社区困境和地理位置在塑造外科手术护理准入方面的复杂相互作用.
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