美国获得已验证烧伤中心治疗的机会存在区域性差异。

Regional disparities in access to verified burn center care in the United States.

机构信息

From the Department of Surgery, University of Colorado (H.C., A.J.W., R.C.M., A.L.W., C.G.V.), Aurora, Colorado.

出版信息

J Trauma Acute Care Surg. 2019 Jul;87(1):111-116. doi: 10.1097/TA.0000000000002259.

DOI:10.1097/TA.0000000000002259

PMID:30865160

Abstract

BACKGROUND

Burn injuries result in 50,000 annual admissions. Despite joint referral criteria from the American College of Surgeons (ACS) and American Burn Association (ABA), many severely injured patients are not treated at verified centers with specialized care. Only one prior study explores regional variation in access to burn centers, focusing on flight or driving distance without considering the size of the population accessing that center. We hypothesize that disparities exist in access to verified centers, measured at a population level. We aim to identify a subset of nonverified centers that, if verified, would most impact access to the highest level of burn care.

METHODS

We collected ABA data for all verified and nonverified adult burn centers and geocoded their locations. We used county-level population data and a two-step floating catchment method to determine weighted access in terms of total beds available locally per population. We compared regions, as defined by the ABA, in terms of overall access. Low access was calculated to be less than 0.3 beds per 100,000 people using a conservative estimate.

RESULTS

We identified 113 centers, 59 verified and 54 nonverified. Only 2.9% of the population lives in areas with no verified center in 300 miles; however, 24.7% live in areas with low access. Significant regional disparities exist, with 37.3% of the population in the Southern Region having low access as compared with just 10.5% in the Northeastern Region. We identified 8 nonverified centers that would most impact access in areas with no or low access.

CONCLUSION

We found significant disparities in access to verified center burn care and determined nonverified centers with the greatest potential to increase access, if verified. Our future directions include identifying barriers to verification, such as lack of fellowship-trained burn surgeons or lack of hospital commitment.

LEVEL OF EVIDENCE

Epidemiological, level III.

摘要

背景

烧伤每年导致 5 万人住院。尽管美国外科医师学院（ACS）和美国烧伤协会（ABA）联合制定了转诊标准，但许多严重烧伤的患者并未在具有专业护理的认证中心接受治疗。仅有一项先前的研究探讨了烧伤中心获取途径的区域差异，重点关注飞行或驾驶距离，而没有考虑到该中心所服务的人口规模。我们假设，在认证中心的获取途径方面存在差异，这可以从人口层面进行衡量。我们旨在确定一组如果获得认证，将对获取最高水平烧伤护理产生最大影响的非认证中心。

方法

我们收集了所有认证和非认证成人烧伤中心的 ABA 数据，并对其位置进行了地理编码。我们使用县一级的人口数据和两步浮动集水法，根据当地每人口可用的总床位来确定加权获取情况。我们根据 ABA 的定义，比较了不同地区的总体获取情况。采用保守估计，将低获取定义为每 10 万人少于 0.3 个床位。

结果

我们确定了 113 个中心，其中 59 个为认证中心，54 个为非认证中心。只有 2.9%的人口居住在 300 英里内没有认证中心的地区；然而，有 24.7%的人口居住在获取途径较低的地区。存在显著的区域差异，南部地区 37.3%的人口获取途径较低，而东北地区仅有 10.5%。我们确定了 8 个非认证中心，如果获得认证，将对无或低获取途径地区的获取途径产生最大影响。