美国获得高质量且可负担得起的外科护理的及时程度趋势

Trends in Timely Access to High-Quality and Affordable Surgical Care in the United States.

作者信息

Mullens Cody Lendon, Ibrahim Andrew M, Clark Nina M, Kunnath Nicholas, Dieleman Joseph L, Dimick Justin B, Scott John W

机构信息

Department of Surgery, University of Michigan. Ann Arbor, MI.

Center for Healthcare Outcomes and Policy, Institute for Health Policy and Innovation, University of Michigan. Ann Arbor, MI.

出版信息

Ann Surg. 2024 Nov 6. doi: 10.1097/SLA.0000000000006586.

DOI:10.1097/SLA.0000000000006586

PMID:39502038

Abstract

OBJECTIVE

To quantify recent trends in access to timely, high-quality, affordable surgical care in the US.

BACKGROUND

Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens.

METHODS

This observational cross-sectional study evaluates multiple domains of access to surgical care across the US from 2011-2015 and 2016-2020. Our stepwise model included timeliness (<60-minute drive time), quality (surgically capable hospital with ≥3 CMS stars), and affordability (neither uninsured nor underinsured) of access to surgical care using a novel combination of data from the American Hospital Association, Medicare claims, CMS's Five-Star Quality Rating System, the American Community Survey, and the Medical Expenditure Panel Survey.

RESULTS

The number of Americans lacking access to timely, high-quality, affordable surgical care increased from 97.7 million in 2010-2015 to 98.7 million in 2016-2020. Comparing these two periods, we found improvements in the number of Americans lacking access due to being uninsured (decrease from 38.5 to 26.5 million). However, these improvements were offset by increasing numbers of Americans for whom timeliness (increase from 9.5 to 14.1 million), quality (increase from 3.4 to 4.9 million), and underinsured status (increase from 46.3 to 53.1 million) increased as barriers to access. Multiple sensitivity analyses using alternative thresholds for each access domain demonstrated similar trends. Those with insufficient access to care tended to be more rural (6.7% vs. 2.0%, P<0.001), lower income (40.7% vs. 30.0%, P<0.001), and of Hispanic ethnicity (35.9% vs. 15.8%, P<0.001).

CONCLUSIONS

Nearly one-in-three Americans lack access to surgical care that is timely, high-quality, and affordable. This study identifies the multiple actionable drivers of access to surgical care that notably can each be addressed with specific policy interventions.

摘要

目的

量化美国近期在获得及时、高质量、可负担的外科护理方面的趋势。

背景

在美国，获得外科护理不足仍是一个持续存在的问题。以往试图了解和量化美国外科护理获取障碍的研究缺乏一个全面的、与政策相关的视角。

方法

这项观察性横断面研究评估了2011 - 2015年和2016 - 2020年美国各地外科护理获取的多个领域。我们的逐步模型包括及时性（驾车时间<60分钟）、质量（拥有≥3颗医疗保险与医疗补助服务中心（CMS）星级的具备手术能力的医院）以及可负担性（既未参保也未未充分参保），使用了来自美国医院协会、医疗保险理赔数据、CMS的五星级质量评级系统、美国社区调查和医疗支出小组调查的新颖数据组合来评估外科护理的获取情况。

结果

无法获得及时、高质量、可负担外科护理的美国人数量从2010 - 2015年的9770万增加到2016 - 2020年的9870万。比较这两个时期，我们发现因未参保而无法获得护理的美国人数量有所改善（从3850万降至2650万）。然而，这些改善被因及时性（从950万增至1410万）、质量（从340万增至490万）和未充分参保状态（从4630万增至5310万）作为获取障碍而增加的美国人数量所抵消。使用每个获取领域的替代阈值进行的多项敏感性分析显示了类似趋势。获得护理不足的人群往往更倾向于居住在农村地区（6.7%对2.0%，P<0.001）、收入较低（40.7%对30.0%，P<0.001）以及为西班牙裔（35.9%对15.8%，P<0.001）。