National Healthcare Quality and Disparities Report
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Topics
- Access to Care (5)
- Adverse Events (2)
- Cancer (3)
- Cancer: Lung Cancer (2)
- Cardiovascular Conditions (3)
- Care Management (1)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- COVID-19 (1)
- Digestive Disease and Health (1)
- (-) Disparities (31)
- Ear Infections (1)
- Education: Patient and Caregiver (1)
- Elderly (3)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Delivery (3)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Health Literacy (1)
- Heart Disease and Health (1)
- Hospital Discharge (2)
- Hospitalization (1)
- Hospitals (2)
- Kidney Disease and Health (1)
- Low-Income (1)
- Medicaid (1)
- Medicare (1)
- Mortality (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Orthopedics (3)
- Outcomes (7)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Practice Patterns (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (18)
- Rural Health (1)
- Sex Factors (1)
- Social Determinants of Health (5)
- (-) Surgery (31)
- Transplantation (1)
- Treatments (1)
- Vulnerable Populations (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 31 Research Studies DisplayedBonner SN, Powell CA, Stewart JW
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
The purpose of this review was to explore effective interventions to reduce inequities and identify gaps in intervention-based research with a goal of increasing awareness of surgeons, surgical trainees, researchers, and policy makers of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. The researchers reviewed the PubMed database for English-language studies published from January 2012 through June 2022 to evaluate interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of literature was conducted identifying interventions that have been related with reduction in racial and ethnic disparities in surgical care. The study found that attaining surgical equity will necessitate implementing evidence-based interventions to improve quality for racial and ethnic minorities, prioritizing funding for intervention-based research, utilizing implementation science and community based-participatory research methods, and principles of learning health systems.
AHRQ-funded; HS026030.
Citation: Bonner SN, Powell CA, Stewart JW .
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
Ann Surg 2023 Aug 1; 278(2):184-92. doi: 10.1097/sla.0000000000005858..
Keywords: Racial and Ethnic Minorities, Disparities, Surgery
Taylor KK, Neiman PU, Bonner S
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
The objective of this study was to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. Researchers used the National Health Interview Survey for 2008-2018 to identify adults aged 18 and older who reported surgery in the past year. The results indicated that unmet social health needs varied significantly by race, ethnicity, and insurance, and were independently associated with poor health among surgical populations.
AHRQ-funded; HS028672; HS027788.
Citation: Taylor KK, Neiman PU, Bonner S .
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
Ann Surg 2023 Aug 1; 278(2):193-200. doi: 10.1097/sla.0000000000005689.
Keywords: Social Determinants of Health, Surgery, Disparities, Outcomes
Johnson CL, Colley A, Pierce L
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
A sudden shift in health condition and the intensification of chronic conditions often necessitate the consideration of emergency general surgery (EGS). While goal-oriented care discussions can enhance goal-concordant care and mitigate feelings of depression and anxiety in patients and caregivers, such conversations, along with standardized documentation, are seldom conducted for EGS patients. The researchers conducted a retrospective cohort study employing data from electronic health records of patients admitted to the EGS service in a high-level academic center to ascertain the frequency of significant advance care planning (ACP) documentation (discussions and legal ACP forms) during EGS hospitalization. Multivariable regression was used to identify patient, clinician, and procedural elements contributing to the absence of ACP. The study found that out of the 681 patients admitted to the EGS service in 2019, only 20.1% had ACP documentation in the electronic health record at any stage during their hospital stay. Two-thirds (65.8%) of the entire cohort underwent surgery during their admission, but none of them had an ACP conversation documented with the surgical team before the operation. Patients with ACP documentation were likely to be insured by Medicare and had a higher incidence of comorbid conditions.
AHRQ-funded; HS024532.
Citation: Johnson CL, Colley A, Pierce L .
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
J Trauma Acute Care Surg 2023 Jun; 94(6):863-69. doi: 10.1097/ta.0000000000003909..
Keywords: Disparities, Surgery, Emergency Department, Chronic Conditions
Mota L, Marcaccio CL, Patel PB
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
This study measured the impact of neighborhood social disadvantage on abdominal aortic aneurysm (AAA) severity and management. The authors identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An area deprivation index (ADI) score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation, which was then divided into quintiles. Outcomes looked at were rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Among the 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%). Increasing ADI quintiles trended towards increasing rAAA and decreasing EVAR rates. In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair and lower odds of undergoing EVAR.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Patel PB .
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
J Vasc Surg 2023 Apr;77(4):1077-86.e2. doi: 10.1016/j.jvs.2022.10.048.
Keywords: Social Determinants of Health, Cardiovascular Conditions, Surgery, Disparities
Ingraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
AHRQ-funded; HS026003.
Citation: Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA .
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities
Herb J, Staley BS, Roberson M
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
The investigators’ objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. Data was obtained using Medicare claims. They found that parathyroidectomy was underused and recommended that quality improvement efforts, rooted in equitable care, be undertaken to increase access to parathyroidectomy for this disease.
AHRQ-funded; HS000032.
Citation: Herb J, Staley BS, Roberson M .
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
Surgery 2021 Nov;170(5):1376-82. doi: 10.1016/j.surg.2021.05.026..
Keywords: Elderly, Disparities, Medicare, Surgery, Racial and Ethnic Minorities
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation: Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Dos Santos Marques IC, Theiss LM, Wood LN
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
The authors hypothesized that racial disparities exist for Hispanic and Asian patients undergoing surgery for inflammatory bowel disease (IBD). Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP) was used. They found that racial disparities do exist among IBD patients undergoing surgery. Black, Hispanic, and Asian IBD patients experience major disparities in post-operative complications, readmissions, and length of stay, respectively, when compared to White patients with IBD. They recommended future research to better understand the mechanisms of these disparities including evaluation of social determinants of health.
AHRQ-funded; HS023009.
Citation: Dos Santos Marques IC, Theiss LM, Wood LN .
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
Am J Surg 2021 Apr;221(4):668-74. doi: 10.1016/j.amjsurg.2020.12.010..
Keywords: Disparities, Racial and Ethnic Minorities, Surgery, Digestive Disease and Health, Outcomes
Pollack LM, Olsen MA, Gehlert SJ
Racial/ethnic disparities/differences in hysterectomy route in women likely eligible for minimally invasive surgery.
The objective of the study was to evaluate racial/ethnic variation in hysterectomy surgical route in women likely eligible for minimally invasive hysterectomy. The investigators concluded that African American, Hispanic, and Asian/PI women eligible for minimally invasive hysterectomy were more likely than White women to receive abdominal hysterectomy. In addition, the proportion of all women undergoing abdominal hysterectomy was highest at hospitals serving higher proportions of African American persons.
AHRQ-funded; HS019455; HS022330.
Citation: Pollack LM, Olsen MA, Gehlert SJ .
Racial/ethnic disparities/differences in hysterectomy route in women likely eligible for minimally invasive surgery.
J Minim Invasive Gynecol 2020 Jul-Aug;27(5):1167-77. doi: 10.1016/j.jmig.2019.09.003..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Women, Surgery
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for African-Americans and Caucasians with enhanced recovery.
The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an enhanced recovery program (ERP). Findings showed that African-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define "health literacy" and suggest the importance of providing health literacy-sensitive care in surgery.
AHRQ-funded; HS023009.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for African-Americans and Caucasians with enhanced recovery.
J Surg Res 2020 Jun;250:12-22. doi: //10.1016/j.jss.2019.12.034..
Keywords: Surgery, Racial and Ethnic Minorities, Patient Experience, Disparities, Health Literacy, Education: Patient and Caregiver
Ezer N, Mhango G, Bagiella E
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
This study examined racial disparities in resection surgery of non-small cell lung cancer (NSCLC). These disparities are well documented. The authors identified 19,624 patients with stage I-II NSCLC 65 years and older from the SEER-Medicare database. They studied patients evaluated by a surgeon within 6 months of diagnosis. Black patients were less likely to undergo resection with resection rates varying among surgeons. Thoracic surgeon specialists were less likely to have any disparities with resection rates.
AHRQ-funded; HS019670.
Citation: Ezer N, Mhango G, Bagiella E .
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
Med Care 2020 Apr;58(4):392-98. doi: 10.1097/mlr.0000000000001280..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Practice Patterns
Garcia RM, Prabhakaran S, Richards CT
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
This study sought to determine if socioeconomic status among minorities indicates higher or lower use of a gastrostomy tube for patients with intracerebral hemorrhage. Patients at a single center were enrolled in an observational cohort study from 2010 to 2017. Zip codes were used to impute socioeconomic status. Of the 512 patients, 18.2% underwent gastrostomy tube placement. Blacks had the highest percentage of placement and Whites the lowest. Only with Hispanics was socioeconomic index independently associated with gastrostomy placement and the lower the income, the less likelihood of gastrostomy use.
AHRQ-funded; HS023437.
Citation: Garcia RM, Prabhakaran S, Richards CT .
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104567. doi: 10.1016/j.jstrokecerebrovasdis.2019.104567.
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Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Surgery, Disparities
Bass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Tipping AD, Nickel KB .
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
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Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Lee T, Qian J, Thamer M
Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients.
In this study, the investigators assessed clinically relevant arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). The investigators concluded that while AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes were uniformly worse in females. They suggest that clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Qian J, Thamer M .
Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients.
Am J Nephrol 2019;49(1):11-19. doi: 10.1159/000495261..
Keywords: Elderly, Sex Factors, Surgery, Kidney Disease and Health, Disparities, Outcomes, Patient-Centered Outcomes Research
Wahl TS, Goss LE, Morris MS
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
The purpose of this study was to investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. The authors hypothesized that ERAS would reduce disparities in pLOS between black and white patients. They concluded that ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications.
AHRQ-funded; HS013852.
Citation: Wahl TS, Goss LE, Morris MS .
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
Ann Surg 2018 Dec;268(6):1026-35. doi: 10.1097/sla.0000000000002307..
Keywords: Surgery, Racial and Ethnic Minorities, Disparities, Care Management, Healthcare Delivery, Hospitalization, Patient-Centered Outcomes Research, Outcomes
Khubchandani JA, Shen C, Ayturk D
Disparities in access to emergency general surgery care in the United States.
This study examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. The study concluded that gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities and policy initiatives need to increase emergency general surgery capacity nationwide.
AHRQ-funded; HS022694.
Citation: Khubchandani JA, Shen C, Ayturk D .
Disparities in access to emergency general surgery care in the United States.
Surgery 2018 Feb;163(2):243-50. doi: 10.1016/j.surg.2017.07.026..
Keywords: Access to Care, Disparities, Emergency Medical Services (EMS), Surgery, Vulnerable Populations
Adelani MA, Keller MR, Barrack RL
The impact of hospital volume on racial differences in complications, readmissions, and emergency department visits following total joint arthroplasty.
This study evaluates the impact of hospital volume on racial differences in outcomes following joint replacement. The study authors concluded that adjusting for hospital volume does not alter the risk of readmissions and ED use associated with minority race/ethnicity, suggesting that hospital volume alone may be insufficient to explain racial differences in outcome.
AHRQ-funded; HS019455.
Citation: Adelani MA, Keller MR, Barrack RL .
The impact of hospital volume on racial differences in complications, readmissions, and emergency department visits following total joint arthroplasty.
J Arthroplasty 2018 Feb;33(2):309-15.e20. doi: 10.1016/j.arth.2017.09.034..
Keywords: Disparities, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Outcomes, Surgery
Witt WP, Coffey RM, Lopez-Gonzalez L
AHRQ Author: Andrews RM, Washington RE
Understanding racial and ethnic disparities in postsurgical complications occurring in U.S. hospitals.
This study of 5,474,067 inpatient surgical discharges examined the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications. It concluded that race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Witt WP, Coffey RM, Lopez-Gonzalez L .
Understanding racial and ethnic disparities in postsurgical complications occurring in U.S. hospitals.
Health Serv Res 2017 Feb;52(1):220-43. doi: 10.1111/1475-6773.12475.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Disparities, Surgery, Adverse Events