Cevallos Priscila, Amakiri Uchechukwu O, Johnstone Thomas, Kim Trudy Sea-Eun, Maheta Bhagvat, Nazerali Rahim, Sheckter Clifford
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif.
Geisel School of Medicine, Dartmouth University, Hanover, N.H.
Plast Reconstr Surg Glob Open. 2023 Apr 5;11(4):e4900. doi: 10.1097/GOX.0000000000004900. eCollection 2023 Apr.
Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies.
The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES.
The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) ( = 0.03). The number of safety net hospitals per program was associated with higher MES ( = 0.02).
Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.
实现健康公平包括在能够体现种族、族裔和社会经济各方面的医疗可及性、治疗和治疗效果的环境中培训外科医生。对健康公平的更多关注催生了用于比较医院的指标。为了确定整形与重建外科（PRS）住院医师培训中健康公平的质量质量，我们计算了美国PRS住院医师培训医院的平均公平分数（MES）。
将2021年洛恩研究所医院指数数据库与美国综合PRS住院医师项目的附属培训医院进行合并。洛恩公平类别由三个领域（社区福利、包容性、薪酬公平）组成，据此得出健康公平等级。计算并报告住院医师项目的MES（标准差）（MES越高表示健康公平性越高）。线性回归模型分析了项目的培训医院数量、安全网医院数量和地理区域对MES的影响。
MES为2.64（0.62）。估计5.9%的项目MES在1至2之间。总体而言，56.5%的项目MES在2至3之间，37.7%的项目MES为3或更高。与参照组（东北部）相比，南部地区的MES较高（P = 0.03）。每个项目的安全网医院数量与较高的MES相关（P = 0.02）。
三分之二的项目在未能体现高度公平医疗服务的机构中培训住院医师。各项目应通过增加附属医院的医疗服务多样性来促进健康公平。这将有助于培养一支能够为社会经济、种族和族裔多样化人群提供医疗服务的PRS工作队伍。
