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Hunter J, Ramirez G, Thirukumaran C, Baumhauer J. Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery. Foot Ankle Int 2024; 45:496-505. [PMID: 38400745 DOI: 10.1177/10711007241230544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND National campaigns in the United States, such as Choosing Wisely, emphasize that decreasing low-value office visits maximizes health care value. Although patient-reported outcomes (PROs) are frequently used to quantify postoperative outcomes, they have not been assessed as a tool to help guide clinicians consider alternatives or discontinue in-person follow-up visits. The purpose of this study is to assess the frequency and cost of in-person follow-up visits after patients report substantial improvement defined as 2 consecutive improvements above preoperative Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores. METHODS Retrospective PROMIS PI data were obtained between 2015 and 2020 for common elective foot (n = 759) and ankle (n = 578) surgical procedures. Patients were divided into quartiles according to their preoperative PI score. Multivariable Cox proportional hazards models were used to investigate time to substantial improvement. Substantial improvement was defined as having 2 consecutive postoperative minimal clinically important differences (MCIDs) above preoperative PROMIS PI scores. MCID was measured using the distribution-based method. Multivariable negative binomial models were used to determine the number of visits and direct associated costs after substantial improvement. The cost to payors was estimated using reimbursement rates. RESULTS Within 3 months, 12% to 46% of foot and 16% to 61% of ankle patients achieved substantial improvement. Results vary by preoperative pain quartile, with patients who report higher preoperative pain scores achieving earlier improvement. After achieving substantial improvement, foot and ankle patients averaged 3.60 and 4.01 follow-up visits during the remaining 9 months of the year. Visit costs averaged $266 and $322 per foot and ankle patient respectively. CONCLUSION Postoperative follow-up visits are time-consuming and costly. Physicians might consider objective measures, such as PROMIS PI, to determine the need, timing, and alternatives for in-person follow-up visits for elective foot and ankle surgeries after patients demonstrate reliable clinical improvement. LEVEL OF EVIDENCE Level III, retrospective cohort study at a single institution.
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Affiliation(s)
- Jefferson Hunter
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Gabriel Ramirez
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Judith Baumhauer
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Rana P, Brennan JC, Johnson AH, Turcotte JJ, Petre BM. Social Determinants of Health in Maryland Hip Arthroscopy Patients. Cureus 2024; 16:e52576. [PMID: 38371015 PMCID: PMC10874623 DOI: 10.7759/cureus.52576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Prior studies have demonstrated racial and socioeconomic disparities in patient-reported outcome measure (PROM) completion rates, and improvement exists across multiple orthopedic conditions. The purpose of this study was to assess whether these disparities are present in patients undergoing hip arthroscopy (HA) procedures. Methods A retrospective study of 306 patients undergoing HA from 2021 to 2023 was performed. Social determinants of health (SDOH) were compared between HA patients and the general Maryland population. Patients were then classified by whether they completed baseline and six-month PROMs (Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) instrument). Patients who completed PROMIS-PF were classified by whether or not they achieved minimal clinically important difference (MCID) at six months. Demographics and SDOH were compared using univariate analyses between patients who did and did not complete PROMs and between those who did and did not achieve MCID. SDOH were evaluated at the zip-code level using regional health information exchange measures. Results Compared to the Maryland population, HA patients resided in areas of lower social vulnerability. Preoperative and six-month PROMs were completed by 102 (33%) patients. No significant differences in demographics or any SDOH were found between patients who did and did not complete PROMs. Six-month MCID was achieved in 75 of 102 (74%) patients with complete PROMs; no significant differences in demographics or SDOH were observed between patients who did and did not achieve MCID. Conclusions For patients undergoing HA, disparities in patient-reported outcome completion rates and postoperative functional improvement do not appear to be present across demographics and SDOH, indicating equitable care is being delivered.
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Affiliation(s)
- Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
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Ye IB, Thomson AE, Chowdhury N, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Telemedicine Improves Access to Care for Spine Patients With Low Socioeconomic Status. Global Spine J 2024; 14:49-55. [PMID: 35403457 PMCID: PMC9006097 DOI: 10.1177/21925682221092398] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The objective of this study is to compare the likelihood of missing a scheduled telemedicine and in-person appointments for spine patients. The secondary objective is to assess the impact of socioeconomic status on missed telemedicine and in-person appointments. METHODS Patients with scheduled outpatient appointments with orthopedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (N = 4,387) and in-person (N = 3810). Socioeconomic status was assessed using Area Deprivation Index (ADI) stratified based on percentile: low (<25), medium (25-75), and high (>75) levels of socioeconomic disadvantage. The primary outcome measure was missed clinic appointments, which was defined as having at least one appointment that was cancelled or labeled "no show." RESULTS Patients with in-person appointments missed appointments more often than patients with telemedicine visits (51.3% vs 24.7%, P < .001). Patients with high ADI missed their in-person appointments more often than patients with medium and low ADI (59.5% vs 52.2% and 47.5%, P < .001). There was no difference in missed telemedicine visits between patients with high, medium, and low ADI (27.6% vs 24.8% vs 23.8%, P = .294). Patients that missed an appointment were 41.9% more likely to be high ADI (OR 1.42, 95% CI 1.20-1.68, P < .001) and 13.4% more likely to be medium ADI (OR 1.13, 95% CI 1.03-1.26, P = .015) compared with low ADI patients. CONCLUSIONS Telemedicine may serve a role in reducing disparity in appointment attendance. While further studies are needed to validate these findings, spine surgeons should consider offering telemedicine as an option to patients.
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Affiliation(s)
- Ivan B. Ye
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexandra E. Thomson
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Navid Chowdhury
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Brittany Oster
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Vincent S. Miseo
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Cavanaugh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Koh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Gelb
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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Hecht CJ, Burkhart RJ, McNassor R, Acuña AJ, Kamath AF. What Is the Geographic Distribution and Density of Orthopaedic Advanced Practice Professionals in Rural Counties? A Large-database Study. Clin Orthop Relat Res 2023; 481:1907-1916. [PMID: 37043552 PMCID: PMC10499078 DOI: 10.1097/corr.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care. This role has been highlighted by projections of nationwide shortages in orthopaedic surgeons, with rural areas expected to be most affected. Given that approximately half of rural counties have no practicing orthopaedic surgeons and that advanced practice professionals have been shown to be more likely to practice in rural areas compared to physicians in other medical disciplines, orthopaedic advanced practice professionals may be poised to address orthopaedic care shortages in rural areas, but the degree to which this is true has not been well characterized. QUESTIONS/PURPOSES (1) What percentage of rural counties have no orthopaedic caregivers, including surgeons and advanced practice professionals? (2) Is the density of advanced practice professionals greater than that of orthopaedic surgeons in rural counties? (3) Do orthopaedic advanced practice professionals only practice in counties that also have practicing orthopaedic surgeons? (4) Are NPs in states with full practice authority more likely to practice in rural counties compared with NPs in restricted practice authority states? METHODS We identified orthopaedic surgeons and advanced practice professionals using the 2019 Medicare Provider Utilization and Payment Data, as this large dataset has been shown to be the most complete source of claims data nationwide. Each professional's ZIP Code was matched to counties per the US Postal Service ZIP Code Crosswalk Files. The total number and density of physician and advanced practice professionals per 100,000 residents were calculated per county nationwide. Counties were categorized as urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) or rural (micropolitan and noncore) using the National Center for Health Statistics Urban-Rural Classification Scheme. Comparisons between rural and urban county caregivers were conducted with the chi-square test and odds ratios. Population densities were compared with the Wilcoxon rank sum test. A bivariate density map was made to visualize the nationwide distribution of orthopaedic caregivers and determine the percentage of rural counties with no orthopaedic caregivers as well as whether orthopaedic advanced practice professionals practiced in counties not containing any surgeons. Additionally, to compare states with NP's full versus restricted practice authority, each NP was grouped based on their state to determine whether NPs in states with full practice authority were more likely to practice in rural counties. We identified a group of 31,091 orthopaedic caregivers, which was comprised of 23,728 physicians, 964 NPs, and 6399 PAs (7363 advanced practice professionals). A total of 88% (20,879 of 23,728) of physicians and 87% (6427 of 7363) of advanced practice professionals were in urban counties, which is comparable to nationwide population distributions. RESULTS A total of 39% (1237 of 3139) of counties had no orthopaedic professionals (defined as orthopaedic surgeons or advanced practice professionals) in 2019. Among these counties, 82% (1015 of 1237) were rural and 18% (222 of 1237) were urban. The density of advanced practice professionals providing orthopaedic services compared with the density of orthopaedic surgeons was higher in rural counties (18 ± 70 versus 8 ± 40 per 100,000 residents; p = 0.001). Additionally, 3% (57 of 1974) of rural and 1% (13 of 1165) of urban counties had at least one orthopaedic advanced practice professional, but no orthopaedic surgeons concurrently practicing in the county. There was no difference between the percentage of rural counties with an NP in states with full versus restricted practice authority for NPs (19% [157 of 823] versus 26% [36 of 141], OR 1.45 [95% CI 0.99 to 2.2]; p = 0.08). CONCLUSION As advanced practice professionals tended to only practice in counties which contain orthopaedic surgeons, our analysis suggests that plans to increase the number of advanced practice professionals alone in rural counties may not be sufficient to fully address the demand for orthopaedic care in rural areas that currently do not have orthopaedic surgeons in practice. Rather, interventions are needed to encourage more orthopaedic surgeons to practice in rural counties in collaborative partnerships with advanced practice professionals. In turn, rural orthopaedic advanced practice professionals may serve to further extend the accessibility of these surgeons, but it remains to be determined what the total number and ratio of advanced practice professionals and surgeons is needed to serve rural counties adequately. CLINICAL RELEVANCE To increase rural orthopaedic outreach, state legislatures may consider providing financial incentives to hospitals who adopt traveling clinic models, incorporating advanced practice professionals in these models as physician-extenders to further increase the coverage of orthopaedic care. Furthermore, the creation of more widespread financial incentives and programs aimed at expanding the experience of trainees in serving rural populations are longer-term investments to foster interest and retention of orthopaedic caregivers in rural settings.
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Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J. Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ryan McNassor
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexander J. Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Sridhar S, Mouat-Hunter A, McCrory B. Rural implementation of the perioperative surgical home: A case-control study. World J Orthop 2023; 14:123-135. [PMID: 36998383 PMCID: PMC10044325 DOI: 10.5312/wjo.v14.i3.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.
AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.
METHODS The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models.
RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.
CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.
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Affiliation(s)
- Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation, College of Public Health, The Ohio State University, Columbus, OH 43210, United States
| | - Amy Mouat-Hunter
- Preanesthesia Clinic, Bozeman Health, Bozeman, MT 59715, United States
| | - Bernadette McCrory
- Mechanical and Industrial Engineering, Montana State University, Bozeman, MT 59715, United States
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Longitudinal Trends in 30-Day Mortality Between Multi-Site and Single-Site Surgeons. Ann Surg 2023; 277:228-232. [PMID: 34520424 DOI: 10.1097/sla.0000000000005210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site versus single-site surgeons. METHODS Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time. RESULTS The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2%-19.0%; 44.3%-41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs 2.50%, P < 0.01). When stratified by system status, multi-site surgeons performed better in-system (2.47% vs 2.58%, P < 0.01); by rural status, multi-site surgeons had lower mortality in non-rural hospitals (2.42% vs 2.51%, P < 0.01). The statistically significant but small mortality advantage of multi-site versus single-site surgeons decreased over time, such that by 2016 there was no difference in outcomes between multi-site and single-site surgeons. CONCLUSION For the majority of study years, multi-site surgeons had lower 30-day mortality than single-site surgeons, but this trend narrowed until outcomes were equivalent by 2016. Surgeons operating at multiple hospitals can provide surgical care to patients without any evidence of increased mortality.
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Orthopaedic Surgeon Distribution in the United States. J Am Acad Orthop Surg 2022; 30:e1188-e1194. [PMID: 36166390 DOI: 10.5435/jaaos-d-22-00271] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is limited research on the supply and distribution of orthopaedic surgeons in the United States. The goal of this study was to analyze the association of orthopaedic surgeon distribution in the United States with geographic and sociodemographic factors. METHODS County-level data from the US Department of Health and Human Services Area Health Resources Files were used to determine the density of orthopaedic surgeons across the United States on a county level. Data were examined from 2000 to 2019 to analyze trends over time. Bivariate and multivariable negative binomial regression models were constructed to identify county-level sociodemographic factors associated with orthopaedic surgeon density. RESULTS In 2019, 51% of the counties in the United States did not have an orthopaedic surgeon. Metropolitan counties had a mean of 22 orthopaedic surgeons per 100,000 persons while nonmetropolitan and rural counties had a mean of 2 and 0.1 orthopaedic surgeons per 100,000 persons, respectively. Over the past 2 decades, there was a significant increase in the percentage of orthopaedic surgeons in metropolitan counties (77% in 2000 vs 93% in 2019, P < 0.001) and in the proportion of orthopaedic surgeons 55 years and older (32% in 2000 vs 39% in 2019, P < 0.001). Orthopaedic surgeon density increased with increasing median home value (P < 0.001) and median household income (P < 0.001). Counties with a higher percentage of persons in poverty (P < 0.001) and higher unemployment rate (P < 0.001) and nonmetropolitan (P < 0.001) and rural (P < 0.001) counties had a lower density of orthopaedic surgeons. On multivariable analysis, a model consisting of median home value (P < 0.001), rural counties (P < 0.001), percentage of noninsured persons (P < 0.001), and percentage of foreign-born persons (P < 0.001) predicted orthopaedic surgeon density. CONCLUSION Access to orthopaedic surgeons in the United States in rural areas is decreasing over time. County-level socioeconomic factors such as wealth and urbanization were found to be closely related with surgeon density.
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Moore JX, Tingen MS, Coughlin SS, O’Meara C, Odhiambo L, Vernon M, Jones S, Petcu R, Johnson R, Islam KM, Nettles D, Albashir G, Cortes J. Understanding geographic and racial/ethnic disparities in mortality from four major cancers in the state of Georgia: a spatial epidemiologic analysis, 1999–2019. Sci Rep 2022; 12:14143. [PMID: 35986041 PMCID: PMC9391349 DOI: 10.1038/s41598-022-18374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
We examined geographic and racial variation in cancer mortality within the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. We analyzed county-level cancer mortality data collected by the Centers for Disease Control and Prevention on breast, colorectal, lung, and prostate cancer mortality among adults (aged ≥ 18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic white (NH-white) and NH-black race/ethnicity. Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: (1) eastern Piedmont to Coastal Plain regions, (2) southwestern rural Georgia area, or (3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-black adults, older adult population, greater poverty, and more rurality. In Georgia, targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-black race/ethnicity, low-income, and rural residents.
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Donaghy C, Smith N, O'Dea F. Orthopaedic Outreach: An innovative programme for orthopaedic patients in remote areas of Newfoundland and Labrador. CANADIAN JOURNAL OF RURAL MEDICINE 2022; 27:143-147. [DOI: 10.4103/cjrm.cjrm_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chioreso C, Gao X, Gribovskaja-Rupp I, Lin C, Ward MM, Schroeder MC, Lynch CF, Chrischilles EA, Charlton ME. Hospital and Surgeon Selection for Medicare Beneficiaries With Stage II/III Rectal Cancer: The Role of Rurality, Distance to Care, and Colonoscopy Provider. Ann Surg 2021; 274:e336-e344. [PMID: 31714306 PMCID: PMC7176526 DOI: 10.1097/sla.0000000000003673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine factors associated with rectal cancer surgery performed at high-volume hospitals (HVHs) and by high-volume surgeons (HVSs), including the roles of rurality and diagnostic colonoscopy provider characteristics. SUMMARY OF BACKGROUND DATA Although higher-volume hospitals/surgeons often achieve superior surgical outcomes, many rectal cancer resections are performed by lower-volume hospitals/surgeons, especially among rural populations. METHODS Patients age 66+ diagnosed from 2007 to 2011 with stage II/III primary rectal adenocarcinoma were selected from surveillance, epidemiology, and end results-medicare data. Patient ZIP codes were used to classify rural status. Hierarchical logistic regression was used to determine factors associated with surgery by HVH and HVS. RESULTS Of 1601 patients, 22% were rural and 78% were urban. Fewer rural patients received surgery at a HVH compared to urban patients (44% vs 65%; P < 0.0001). Compared to urban patients, rural patients more often had colonoscopies performed by general surgeons (and less often from gastroenterologists or colorectal surgeons), and lived substantially further from HVHs; these factors were both associated with lower odds of surgery at a HVH or by a HVS. In addition, whereas over half of both rural and urban patients received their colonoscopy and surgery at the same hospital, rural patients who stayed at the same hospital were significantly less likely to receive surgery at a HVH or by a HVS compared to urban patients. CONCLUSIONS Rural rectal cancer patients are less likely to receive surgery from a HVH/HVS. The role of the colonoscopy provider has important implications for referral patterns and initiatives seeking to increase centralization.
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Affiliation(s)
- Catherine Chioreso
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Xiang Gao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Marcia M. Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA
| | - Mary C. Schroeder
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA
| | | | - Mary E. Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA
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Telephone consultation service in orthopedics during COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 65:167-171. [PMID: 34040680 PMCID: PMC8045449 DOI: 10.1016/j.recote.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
Background and aim The current COVID-19 pandemic scenario has driven surgical departments to a transformation. The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation. They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved. 53% of all telematic visits were successful. Conclusions Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.
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Greenfield PT, Manz WJ, DeMaio EL, Duddleston SH, Xerogeanes JW, Scott Maughon T, Spencer CC, Dawes A, Boden SD, Hammond KE, Wagner ER, Gottschalk MB, Daly CA, Pombo MW. Telehealth Can Be Implemented Across a Musculoskeletal Service Line Without Compromising Patient Satisfaction. HSS J 2021; 17:36-45. [PMID: 33967640 PMCID: PMC8077987 DOI: 10.1177/1556331620977171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022]
Abstract
Background: The COVID-19 pandemic has led to changes to in-office orthopedic care, with a rapid shift to telemedicine. Institutions' lack of established infrastructure for these types of visits has posed challenges requiring attention to confidentiality, safety, and patient satisfaction. Purpose: The aim of this study was to analyze the feasibility of telemedicine in orthopedics during the pandemic and its effect on efficiency and patient satisfaction. Methods: Patients seen by the Emory University Department of Orthopaedics Sports Medicine and Upper Extremity Divisions via telemedicine from March 23 to April 24, 2020, were contacted by telephone. Each patient was asked to respond to questions on satisfaction, ease of use, and potential future use; satisfaction with telemedicine and previous clinical visits were measured using a modified 5-point Likert scale. Results: Of the 762 patients seen, 346 (45.4%) completed the telemedicine questionnaire. Satisfaction varied by visit type, with average scores of 4.88/5 for in-office clinic visits versus 4.61/5 for telemedicine visits. There was no significant difference among age groups for satisfaction ratings. Patients 65 years old or older reported significantly longer visit times and decreased ease of use with the telemedicine platform. Conclusion: Telemedicine in a large orthopedics department was successfully implemented without compromising patient satisfaction. The use of telemedicine allows many patients to be seen quickly and efficiently without diminishing their musculoskeletal clinical experience.
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Affiliation(s)
| | - Wesley J. Manz
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Emily L. DeMaio
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | | | - T. Scott Maughon
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Corey C. Spencer
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Alexander Dawes
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Scott D. Boden
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Kyle E. Hammond
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Charles A. Daly
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Mathew W. Pombo
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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13
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Miguela Álvarez SM, Bartra Ylla A, Salvador Carreño J, Castillón P, García Cardona C, Anglès Crespo F. Telephone consultation service in orthopedics during COVID-19 pandemic. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:167-171. [PMID: 33422454 PMCID: PMC7832733 DOI: 10.1016/j.recot.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Antecedentes y objetivo Durante la pandemia COVID-19, la actividad de los servicios quirúrgicos se ha visto obligada a adaptarse y transformarse. La telemedicina se está implantando como nunca antes en esta nueva situación, en la que los pacientes están confinados y los profesionales sanitarios presentan riesgo de infectarse. El objetivo es mostrar que una reestructuración combinada telemática y presencial de las visitas, permite asegurar la asistencia médica, garantizando la protección del personal sanitario y de los pacientes. Material y método Estudio descriptivo observacional sobre el seguimiento de pacientes durante la pandemia por COVID-19, combinando la consulta telefónica con la presencial. Resultados Se realizaron un total de 5.031 llamadas telefónicas, diferenciando entre derivaciones, visitas de atención primaria especializada y consulta externa hospitalaria. Se registraron como: efectivas, tributarias de visita presencial y no se logra contacto telefónico. Y las dividimos en dos grupos: resueltas y no resueltas. Del total de visitas no presenciales telefónicas fueron efectivas un 53%. Conclusiones La medicina telemática es una opción factible en un servicio de traumatología, y de manera adecuada será una opción interesante de mantener tras la pandemia. Futuras líneas de investigación deberían ser abiertas para mejorar la capacidad de resolución de este sistema, analizar su relación coste-efectividad y subsanar los conflictos legales que pudieran existir.
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Affiliation(s)
- S M Miguela Álvarez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España.
| | - A Bartra Ylla
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España
| | - J Salvador Carreño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - P Castillón
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - C García Cardona
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España
| | - F Anglès Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departamento de Cirugía, Universitat de Barcelona (UB), Barcelona, España
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14
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Affiliation(s)
- Peter B White
- Department of Orthoepaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Randy M Cohn
- Department of Orthoepaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, and the Berman Institute, Johns Hopkins University, Baltimore, Maryland
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15
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Departmental Experience and Lessons Learned With Accelerated Introduction of Telemedicine During the COVID-19 Crisis. J Am Acad Orthop Surg 2020; 28:e469-e476. [PMID: 32301818 PMCID: PMC7195846 DOI: 10.5435/jaaos-d-20-00380] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite the use of digital technology in healthcare, telemedicine has not been readily adopted. During the COVID-19 pandemic, healthcare systems have begun crisis management planning. To appropriately allocate resources and prevent virus exposure while maintaining effective patient care, our orthopaedic surgery department rapidly introduced a robust telemedicine program during a 5-day period. Implementation requires attention to patient triage, technological resources, credentialing, education of providers and patients, scheduling, and regulatory considerations. This article provides practical instruction based on our experience for physicians who wish to implement telemedicine during the COVID-19 pandemic. Between telemedicine encounters and necessary in-person visits, providers may be able to achieve 50% of their typical clinic volume within 2 weeks. When handling the massive disruption to the routine patient care workflow, it is critical to understand the key factors associated with an accelerated introduction of telemedicine for the safe and effective continuation of orthopaedic care during this pandemic. LEVEL OF EVIDENCE:: V.
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16
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Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019; 19:974. [PMID: 31852493 PMCID: PMC6921587 DOI: 10.1186/s12913-019-4815-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.
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Affiliation(s)
- Melissa E Cyr
- School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna G Etchin
- VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, 02130, USA
| | - Barbara J Guthrie
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
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17
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Humbyrd CJ. Virtue Ethics in a Value-driven World: Ethical Telemedicine. Clin Orthop Relat Res 2019; 477:2639-2641. [PMID: 31764325 PMCID: PMC6907287 DOI: 10.1097/corr.0000000000000908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Casey Jo Humbyrd
- C. J. Humbyrd, Assistant Professor of Orthopaedic Surgery and Chief, Foot and Ankle Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Lese A, Sraj S. Rural Orthopedics: Providing Orthopedic Care in Rural Communities. Orthopedics 2019; 42:e350-e355. [PMID: 31323106 DOI: 10.3928/01477447-20190624-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
Providing orthopedic care to rural communities is challenging. Delivering adequate orthopedic care is challenged by delay in presentation, underestimation of urgency, need for subspecialty services, and deficiencies in local support services. Collaboration efforts, peer-to-peer consultations, outreach clinics, virtual consults, electronic consults, and telemedicine are useful strategies. Individual treatment strategy must accommodate the burden on the patient, and patient education is important. Treatment options that require frequent travel should be avoided. Orthopedic surgery is in high demand in rural communities but unfortunately is limited in availability. Strategies are available for improving access to orthopedic care in rural areas. [Orthopedics. 2019; 42(4):e350-e355.].
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19
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Affiliation(s)
- Rajesh Malhotra
- Chief, JPN Apex Trauma Centre, Prof and Head of Orthopedics, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Rajesh Malhotra, Room No 5036, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:
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20
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Mulcahey MK, Kenter K, Black KP. The General Orthopaedist: Going the Way of the Dinosaur or the Next Subspecialty?: AOA Critical Issues. J Bone Joint Surg Am 2018; 100:e96. [PMID: 30020134 DOI: 10.2106/jbjs.17.01109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Orthopaedic specialization has increased substantially over the past several decades, partly due to the desire of residents to improve their clinical expertise and to increase the likelihood that they will obtain a position with better compensation and a more balanced lifestyle. The American Academy of Orthopaedic Surgeons (AAOS) census data support this trend, demonstrating a substantial rise in the percentage of practicing orthopaedic surgeons who identify themselves as specialists rather than as general orthopaedic surgeons. There is a perception that a more narrowed scope of practice may prevent the current orthopaedic workforce from being able to adequately care for populations in rural areas of the United States. Additional consideration should be given to clearly defining the necessary knowledge and skills of a general orthopaedist in the twenty-first century, to understanding their role in musculoskeletal care, and to reevaluating residency educational experiences relative to their ability to prepare graduates to practice general orthopaedics independently.
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Affiliation(s)
- Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Keith Kenter
- Department of Orthopaedic Surgery, Western Michigan University, Kalamazoo, Michigan
| | - Kevin P Black
- Department of Orthopaedic Surgery, Penn State Hershey, Hershey, Pennsylvania
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21
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Moore JX, Royston KJ, Langston ME, Griffin R, Hidalgo B, Wang HE, Colditz G, Akinyemiju T. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes Control 2018; 29:737-750. [PMID: 29922896 DOI: 10.1007/s10552-018-1051-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/13/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics. METHODS We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity. RESULTS Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care. CONCLUSIONS We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.
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Affiliation(s)
- Justin Xavier Moore
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA. .,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, TAB 2nd Floor Suite East, 7E, Saint Louis, MO, 63110-1093, USA.
| | - Kendra J Royston
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marvin E Langston
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Russell Griffin
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bertha Hidalgo
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Graham Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Tomi Akinyemiju
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Epidemiology, University of Kentucky, Lexington, KY, USA
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Caldwell RI, Grant M, Gaede B, Aldous C. Enabling factors for specialist outreach in western KwaZulu-Natal. Afr J Prim Health Care Fam Med 2018; 10:e1-e10. [PMID: 29781691 PMCID: PMC5968876 DOI: 10.4102/phcfm.v10i1.1690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 11/06/2022] Open
Abstract
Background There exists a major disparity in access to specialist care between patients in urban and rural areas. Specialists are a scarce resource and are concentrated in urban areas. Specialist outreach attempts to fill the gap in service provision for patients situated remotely. While there is international evidence that multifaceted specialist outreach has achieved varying levels of success, factors that influence the effectiveness of outreach have not yet been fully elucidated in South Africa. Aim This study attempts to uncover some of the factors that enable good multifaceted specialist outreach. Setting The study was conducted in hospitals in western KwaZulu-Natal province. This health area is served by a tertiary hospital and 20 peripheral hospitals; three of these are regional level and the majority are district level hospitals. Specialist outreach emanates from the tertiary hospital. Methods Specialists providing outreach services from the tertiary hospital and medical officers at seven receiving hospitals were interviewed to explore perceptions regarding factors that might enable successful specialist outreach. Framework analysis on the transcribed interviews was carried out using NVivo version 11. Results A major positive finding concerns the relationships formed between outreach specialists and doctors at the recipient hospitals. The management of the programme with respect to structure, dependability, data management, transport provision, communication technology and public health systems was also seen as beneficial in specialist outreach. Conclusion Specialist outreach plays an essential role in providing equality in health care. To enable effectiveness, it is important to make full use of the multifaceted nature of this intervention.
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Sarmiento EJ, Moore JX, McClure LA, Griffin R, Al-Hamdan MZ, Wang HE. Fine Particulate Matter Pollution and Risk of Community-Acquired Sepsis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040818. [PMID: 29690517 PMCID: PMC5923860 DOI: 10.3390/ijerph15040818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/28/2022]
Abstract
While air pollution has been associated with health complications, its effect on sepsis risk is unknown. We examined the association between fine particulate matter (PM2.5) air pollution and risk of sepsis hospitalization. We analyzed data from the 30,239 community-dwelling adults in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort linked with satellite-derived measures of PM2.5 data. We defined sepsis as a hospital admission for a serious infection with ≥2 systemic inflammatory response (SIRS) criteria. We performed incidence density sampling to match sepsis cases with 4 controls by age (±5 years), sex, and race. For each matched group we calculated mean daily PM2.5 exposures for short-term (30-day) and long-term (one-year) periods preceding the sepsis event. We used conditional logistic regression to evaluate the association between PM2.5 exposure and sepsis, adjusting for education, income, region, temperature, urbanicity, tobacco and alcohol use, and medical conditions. We matched 1386 sepsis cases with 5544 non-sepsis controls. Mean 30-day PM2.5 exposure levels (Cases 12.44 vs. Controls 12.34 µg/m3; p = 0.28) and mean one-year PM2.5 exposure levels (Cases 12.53 vs. Controls 12.50 µg/m3; p = 0.66) were similar between cases and controls. In adjusted models, there were no associations between 30-day PM2.5 exposure levels and sepsis (4th vs. 1st quartiles OR: 1.06, 95% CI: 0.85–1.32). Similarly, there were no associations between one-year PM2.5 exposure levels and sepsis risk (4th vs. 1st quartiles OR: 0.96, 95% CI: 0.78–1.18). In the REGARDS cohort, PM2.5 air pollution exposure was not associated with risk of sepsis.
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Affiliation(s)
- Elisa J Sarmiento
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, RPHB, Birmingham, AL 35233, USA.
| | - Justin Xavier Moore
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, RPHB, Birmingham, AL 35233, USA.
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO 63110, USA.
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19104, USA.
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, RPHB, Birmingham, AL 35233, USA.
| | - Mohammad Z Al-Hamdan
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA.
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, 6431 Fannin St., JJL 434, Houston, TX 77030, USA.
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24
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Cummings NM, Harmer L, Smith G, Masri B, Loefler A. Orthopaedic Care in Underserved Areas-What Are We Going to Do? Symposium Presented at the AOA Annual Meeting, June 23, 2016: AOA Critical Issues. J Bone Joint Surg Am 2017; 99:e134. [PMID: 29257022 DOI: 10.2106/jbjs.16.01413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - Bas Masri
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Loefler
- Australian Orthopaedic Association, Sydney, New South Wales, Australia
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25
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Moore JX, Akinyemiju T, Wang HE. Pollution and regional variations of lung cancer mortality in the United States. Cancer Epidemiol 2017; 49:118-127. [PMID: 28601785 DOI: 10.1016/j.canep.2017.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/25/2017] [Accepted: 05/29/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The aims of this study were to identify counties in the United States (US) with high rates of lung cancer mortality, and to characterize the associated community-level factors while focusing on particulate-matter pollution. METHODS We performed a descriptive analysis of lung cancer deaths in the US from 2004 through 2014. We categorized counties as "clustered" or "non-clustered" - based on whether or not they had high lung cancer mortality rates - using novel geospatial autocorrelation methods. We contrasted community characteristics between cluster categories. We performed logistic regression for the association between cluster category and particulate-matter pollution. RESULTS Among 362 counties (11.6%) categorized as clustered, the age-adjusted lung cancer mortality rate was 99.70 deaths per 100,000 persons (95%CI: 99.1-100.3). Compared with non-clustered counties, clustered counties were more likely in the south (72.9% versus 42.1%, P<0.01) and in non-urban communities (73.2% versus 57.4, P<0.01). Clustered counties had greater particulate-matter pollution, lower education and income, higher rates of obesity and physical inactivity, less access to healthcare, and greater unemployment rates (P<0.01). Higher levels of particulate-matter pollution (4th quartile versus 1st quartile) were associated with two-fold greater odds of being a clustered county (adjusted OR: 2.10; 95%CI: 1.23-3.59). CONCLUSION We observed a belt of counties with high lung mortality ranging from eastern Oklahoma through central Appalachia; these counties were characterized by higher pollution, a more rural population, lower socioeconomic status and poorer access to healthcare. To mitigate the burden of lung cancer mortality in the US, both urban and rural areas should consider minimizing air pollution.
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Affiliation(s)
- Justin Xavier Moore
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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