与农村地区小儿普通外科门诊医疗可及性相关的患者因素。

Patient Factors Associated with Access to Outpatient Pediatric General Surgical Care in a Rural State.

作者信息

Krinock Derek J, Birisci Esma, Wyrick Deidre L, Maxson Robert T, Dassinger Melvin S, Wolf Lindsey L

机构信息

Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Department of Econometrics, Bursa Uludag University, Bursa, Turkey.

出版信息

J Pediatr Surg. 2025 Jan;60(1):161899. doi: 10.1016/j.jpedsurg.2024.161899. Epub 2024 Sep 6.

DOI:10.1016/j.jpedsurg.2024.161899

PMID:39341779

Abstract

BACKGROUND

We sought to understand factors impacting timely access to outpatient pediatric general surgical care in a largely rural state.

METHODS

We conducted a multi-site retrospective cohort study, evaluating patients <18 years referred for outpatient pediatric general surgical evaluation from 11/1/2017-7/31/2022. Outcomes included obtaining an appointment, completing an appointment, and undergoing an operation. Time to appointment and operation were calculated. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient factors and the primary outcomes, as well as delay to appointment.

RESULTS

Of 5270 patients, mean age was 7.1 years (SD = 6) with 59% male. All patients obtained an appointment; 85% (n = 4498) completed an appointment within one year. Forty percent (n = 2092) underwent an operation. Mean times from referral to appointment and operation were 22.5 (SD = 33.4) and 81.5 days (SD = 137.5), respectively. Patients who identified as African American/Black (OR = 1.94, p < 0.001), had self-pay (OR = 6.33, p < 0.001), or lived >100 miles away (OR = 1.55, p < 0.001) were more likely to not complete appointments. Patients with high household income (OR = 0.70, p = 0.009) and private insurance (OR = 0.60, p < 0.001) were less likely to not complete appointments. Delay to appointment was associated with race (p = 0.020). Patients with private insurance (p < 0.001) and higher income (p = 0.020) were more likely to undergo operation.

CONCLUSION

Fifteen percent of patients referred for outpatient pediatric general surgical evaluation did not complete an appointment within one year. Race, household resources, insurance, and travel distance were associated with completing appointments. Information about groups that have disparate access to care will inform interventions to improve this access.

TYPE OF STUDY

Retrospective Cohort Study.

LEVEL OF EVIDENCE

III.

摘要

背景

我们试图了解在一个以农村为主的州，影响及时获得小儿普通外科门诊护理的因素。

方法

我们进行了一项多中心回顾性队列研究，评估了2017年11月1日至2022年7月31日期间转诊进行小儿普通外科门诊评估的18岁以下患者。结果包括获得预约、完成预约和接受手术。计算了预约时间和手术时间。进行了双变量分析和多变量逻辑回归，以评估患者因素与主要结果之间的关联，以及预约延迟情况。

结果

在5270名患者中，平均年龄为7.1岁（标准差=6），男性占59%。所有患者都获得了预约；85%（n=4498）在一年内完成了预约。40%（n=2092）接受了手术。从转诊到预约和手术的平均时间分别为22.5天（标准差=33.4）和81.5天（标准差=137.5）。自我认定为非裔美国人/黑人的患者（比值比=1.94，p<0.001）、自费患者（比值比=6.33，p<0.001）或居住在100英里以外的患者（比值比=1.55，p<0.001）更有可能未完成预约。家庭收入高的患者（比值比=0.70，p=0.009）和拥有私人保险的患者（比值比=0.60，p<0.001）未完成预约的可能性较小。预约延迟与种族有关（p=0.020）。拥有私人保险的患者（p<0.001）和收入较高的患者（p=0.020）更有可能接受手术。