Bradley Cathy J, Dahman Bassam, Sabik Lindsay M
Virginia Commonwealth University, Department of Healthcare Policy and Research and Massey Cancer Center, PO Box 980430, Richmond, VA 23298-0430. Email:
Am J Manag Care. 2015 Feb 1;21(2):e161-70.
We examined whether safety net hospitals reduce the likelihood of emergency colorectal cancer (CRC) surgery in uninsured and Medicaid-insured patients. If these patients have better access to care through safety net providers, they should be less likely to undergo emergency resection relative to similar patients at non- safety net hospitals.
Using population-based data, we estimated the relationship between safety net hospitals, patient insurance status, and emergency CRC surgery. We extracted inpatient admission data from the Virginia Health Information discharge database and matched them to the Virginia Cancer Registry for patients aged 21 to 64 years who underwent a CRC resection between January 1, 1999, and December 31, 2005 (n = 5488).
We differentiated between medically defined emergencies and those that originated in the emergency department (ED). For each definition of emergency surgery, we estimated the linear probability models of the effects of being treated at a safety net hospital on the probability of having an emergency resection.
Safety net hospitals reduce emergency surgeries among uninsured and Medicaid CRC patients. When defining an emergency resection as those that involved an ED visit, these patients were 15 to 20 percentage points less likely to have an emergency resection when treated in a safety net hospital.
Our results suggest that these hospitals provide a benefit, most likely through the access they afford to timely and appropriate care, to uninsured and Medicaid-insured patients relative to hospitals without a safety net mission.
我们研究了安全网医院是否降低了未参保和医疗补助参保患者进行急诊结直肠癌（CRC）手术的可能性。如果这些患者通过安全网医疗机构能更好地获得医疗服务，那么相对于非安全网医院的类似患者，他们接受急诊切除手术的可能性应该更低。
利用基于人群的数据，我们估计了安全网医院、患者保险状况与急诊CRC手术之间的关系。我们从弗吉尼亚健康信息出院数据库中提取了住院患者入院数据，并将其与弗吉尼亚癌症登记处的数据进行匹配，对象为1999年1月1日至2005年12月31日期间接受CRC切除手术的21至64岁患者（n = 5488）。
我们区分了医学定义的紧急情况和起源于急诊科（ED）的紧急情况。对于每种急诊手术的定义，我们估计了在安全网医院接受治疗对急诊切除概率影响的线性概率模型。
安全网医院减少了未参保和医疗补助CRC患者的急诊手术。当将急诊切除定义为涉及急诊科就诊的手术时，这些患者在安全网医院接受治疗时进行急诊切除的可能性要低15至20个百分点。
我们的结果表明，相对于没有安全网使命的医院，这些医院为未参保和医疗补助参保患者提供了益处，很可能是通过它们所提供的及时和适当医疗服务的途径。
