Ha Chrysanthy, Carroll Nathan, Steen Shawn, Romero Javier, Diaz Graal
Surgery, Community Memorial Hospital, Ventura, USA.
Family Medicine, Ventura County Medical Center, Ventura, USA.
Cureus. 2024 Nov 25;16(11):e74419. doi: 10.7759/cureus.74419. eCollection 2024 Nov.
This study addresses the intricate landscape of racial disparities in healthcare delivery, with a specific focus on surgical procedures. The concern was accentuated by the challenges posed during the COVID-19 pandemic when resources became scarce. Recognizing the potential impact of provider bias in medical decision-making, the American College of Surgeons introduced the Medically Necessary and Time-Sensitive (MeNTS) scoring system. This methodology aims to address procedures that, while not emergent, are deemed medically necessary and time-sensitive. This study analyzed whether using this scoring system decreased racial disparities between patients receiving surgery during the pandemic.
A retrospective cross-sectional study was conducted using Electronic Medical Records from June 1, 2020, to December 31, 2021. We analyzed variations in MeNTS scores and time to surgery based on racial and ethnic backgrounds using bivariate and multivariate analyses.
The analysis included 2,997 patients. Of these, 1,442 (42.84%) were Hispanic participants, 1,282 (38.09%) were non-Hispanic participants, and 642 (19.07%) were participants of other specified ethnic backgrounds. The racial composition comprised 2,955 (87.79%) White participants, 98 (2.91%) Asian participants, 50 (1.49%) African American participants, and 72 (2.14%) Alaska Native or American Indian participants. No significant differences in mean days to surgery or MeNTS scores were observed across racial and ethnic groups (Hispanic participants = 76.62 vs. non-Hispanic participants = 78.82, = 0.8). A multivariate survival model showed that MeNTS scores below 30 were associated with higher surgery likelihood, with no significant disparities in race, ethnicity, or gender.
This comprehensive study utilizing the MeNTS scoring system reveals an absence of statistically significant racial disparities in surgical prioritization. These findings contribute valuable insights to the ongoing discourse surrounding equitable healthcare practices and emphasize the potential efficacy of standardized scoring systems in mitigating biases in medical decision-making.
本研究探讨了医疗服务中种族差异的复杂情况，特别关注外科手术。在新冠疫情期间，资源变得稀缺，这一问题更加突出。认识到医疗服务提供者的偏见在医疗决策中可能产生的影响，美国外科医师学会引入了医疗必需且时间敏感（MeNTS）评分系统。该方法旨在处理那些虽非紧急但被认为医疗必需且时间敏感的手术。本研究分析了使用该评分系统是否减少了疫情期间接受手术患者之间的种族差异。
采用回顾性横断面研究，使用2020年6月1日至2021年12月31日的电子病历。我们使用双变量和多变量分析，根据种族和族裔背景分析了MeNTS评分和手术时间的差异。
分析纳入了2997名患者。其中，1442名（42.84%）为西班牙裔参与者，1282名（38.09%）为非西班牙裔参与者，642名（19.07%）为其他特定族裔背景的参与者。种族构成包括2955名（87.79%）白人参与者，98名（2.91%）亚洲参与者，50名（1.49%）非裔美国参与者，以及72名（2.14%）阿拉斯加原住民或美洲印第安参与者。在不同种族和族裔群体中，手术平均天数或MeNTS评分未观察到显著差异（西班牙裔参与者=76.62，非西班牙裔参与者=78.82，P=0.8）。多变量生存模型显示，MeNTS评分低于30与手术可能性较高相关，在种族、族裔或性别方面没有显著差异。
这项使用MeNTS评分系统的综合研究表明，在手术优先级方面不存在统计学上显著的种族差异。这些发现为围绕公平医疗实践的持续讨论提供了有价值的见解，并强调了标准化评分系统在减轻医疗决策偏见方面的潜在功效。
