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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 24 of 24 Research Studies Displayed
Greenberg JK, Brown DS, Olsen MA
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
This study's goal was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. The authors evaluated elective spinal surgeries performed in the U.S. from 2011 to 2016 and included 10 states with expanded Medicaid access and 4 states that did not. They identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% increase in mean hospital spine surgical volume and a 23% increase in Medicaid volume. Privately insured surgical volumes did not change significantly. This increase indicated improved access to care.
Citation: Greenberg JK, Brown DS, Olsen MA . Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care. J Neurosurg Spine 2022 Feb;36(2):336–44. doi: 10.3171/2021.3.Spine2122..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Access to Care, Surgery
Johnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
Citation: Johnson CL, Schwartz H, Greenberg A . Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic. J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords: COVID-19, Surgery, Access to Care, Patient Experience, Public Health
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.
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 / Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Chao GF, Li KY, Zhu Z
Use of telehealth by surgical specialties during the COVID-19 pandemic.
This study’s objective was to determine telehealth use by surgical specialty before and during the pandemic period starting in March 2020. Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020) were analyzed. For new patient visits, 1182 surgeons (26.8%) in any patient context used telehealth. Telehealth use peaked in April 2020 and facilitated 34.6% of all new patient visits during that week. Urology was the specialty with the highest telehealth conversion rate (14.3%).
Citation: Chao GF, Li KY, Zhu Z . Use of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surg 2021 Jul;156(7):620-26. doi: 10.1001/jamasurg.2021.0979..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Access to Care, Practice Patterns, Surgery
Kemp MT, Williams AM, Brown CS
Practical guidance for early identification of barriers in surgical telehealth clinics.
The authors provide advice on early identification of and response to barriers in telehealth settings in order to help patients receive optimal care. Their focus is on standardizing expectations, assessing technological knowledge and resource access, evaluating understanding and comfort with telehealth, and assessing social support.
Citation: Kemp MT, Williams AM, Brown CS . Practical guidance for early identification of barriers in surgical telehealth clinics. Ann Surg 2021 Jun;273(6):e268-e70. doi: 10.1097/sla.0000000000004633..
Keywords: Surgery, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to Care
Dy CJ, Salter A, Barker A
Increased utilization of total joint arthroplasty after Medicaid expansion.
This study examined prior analyses that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) was to be expected after Medicaid expansion in 2014. Using 2012-2015 data from the HCUP Database, 9 expansion states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York, and Vermont) were compared to 2 states that did not expand Medicaid (Florida and Missouri). After adjusting for community characteristics, THA and TKA increased 15% in 2014 and 23% in 2015 within expansion states compared to 2013. In non-expansion states, compared to 2013, there were significant decreases of 18% in 2014 and 11% in 2015.
Citation: Dy CJ, Salter A, Barker A . Increased utilization of total joint arthroplasty after Medicaid expansion. J Bone Joint Surg Am 2021 Mar 17;103(6):524-31. doi: 10.2106/jbjs.20.00303..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Orthopedics, Surgery, Healthcare Utilization, Access to Care
Ingraham AM, Chaffee SM, Ayturk MD
Gaps in emergency general surgery coverage in the United States.
Researchers sought to measure gaps in round-the-clock emergency general surgery (EGS) care via a survey of all US adult acute care general hospitals with an emergency room, at least 1 operating room. They found that 17.1% of hospitals responding were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for this lack. However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
AHRQ-funded; HS025224; HS022694.
Citation: Ingraham AM, Chaffee SM, Ayturk MD . Gaps in emergency general surgery coverage in the United States. Ann Surg Open 2021 Mar;2(1). doi: 10.1097/as9.0000000000000043..
Keywords: Surgery, Emergency Department, Hospitals, Access to Care, Workforce
Cohen C, Baird M, Koirola N
The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination.
This mixed-methods study described the distribution of the surgical and anesthesia workforce and qualitatively explored how such workforce and other factors influenced rural hospitals' provision of surgical services. Using American Hospital Association survey data, the researchers found that within rural counties, 55.1% had no surgeon, 81.2% had no anesthesiologist, and 58.1% had no Certified Registered Nurse Anesthetist. While rural hospitals reported meeting community needs for elective and noncomplex surgeries, these hospitals continued to face significant challenges providing subspecialty surgeries, emergency surgeries, and 24-hour obstetrical services.
Citation: Cohen C, Baird M, Koirola N . The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination. J Rural Health 2021 Jan;37(1):45-54. doi: 10.1111/jrh.12417..
Keywords: Rural Health, Access to Care, Surgery, Workforce, Provider: Physician, Provider: Nurse, Provider, Hospitals
Leeds IL, Jones C, DiBrito SR
Delay in emergency hernia surgery is associated with worse outcomes.
The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. The National Surgical Quality Improvement Program (NSQIP) database was searched for emergent surgeries in 2011-2016 for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Findings showed that delayed surgery was associated with increased rates of major complications, longer operative times, longer postoperative lengths of stay, increased re-operations, increased readmissions, and increased 30-day mortality. Next-day surgery and surgery delayed more than one day were associated with increased odds of a major complication.
Citation: Leeds IL, Jones C, DiBrito SR . Delay in emergency hernia surgery is associated with worse outcomes. Surg Endosc 2020 Oct;34(10):4562-73. doi: 10.1007/s00464-019-07245-4..
Keywords: Surgery, Quality Improvement, Quality of Care, Critical Care, Access to Care, Digestive Disease and Health, Outcomes
Herb JN, Dunham LN, Mody G
Lung cancer surgical regionalization disproportionately worsens travel distance for rural patients.
Researchers hypothesized that lung cancer patients have been traveling further for surgery over time as regionalization has occurred, and this increased travel has primarily impacted rural patients. Using data from a North Carolina all-payer state discharge database, they found that the number of hospitals performing lung cancer resections decreased from 49 to 31 over the study period, and the proportion of patients receiving care at high-volume centers increased. Rural patient travel distance increased over time by 8.5 miles, with no change in urban patient travel distance. They concluded that, in North Carolina, lung cancer surgical regionalization occurred over the study period and was accompanied by increases in travel distance for rural patients only. They recommended further work to determine the effects of greater travel distance on patterns of cancer care for rural patients.
Citation: Herb JN, Dunham LN, Mody G . Lung cancer surgical regionalization disproportionately worsens travel distance for rural patients. J Rural Health 2020 Sep;36(4):496-505. doi: 10.1111/jrh.12440..
Keywords: Cancer: Lung Cancer, Cancer, Rural Health, Surgery, Access to Care
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
Citation: Mogul DB, Perito ER, Wood N . Impact of acuity circles on outcomes for pediatric liver transplant candidates. Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Vu JV, Gunaseelan V, Dimick JB
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Black patients and older adults are less likely to receive minimally invasive hernia repair. In this study, the investigators explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. The investigators concluded that race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients.
Citation: Vu JV, Gunaseelan V, Dimick JB . Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair. Surg Endosc 2019 Dec;33(12):4032-37. doi: 10.1007/s00464-019-06695-0..
Keywords: Racial / Ethnic Minorities, Surgery, Elderly, Access to Care, Healthcare Utilization
Ricci KB, Rushing AP, Ingraham AM
The association between self-declared acute care surgery services and operating room access: results from a national survey.
In this study, the investigators conducted a national survey on emergency general surgery (EGS) structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared with a traditional general surgeon on call (GSOC) approach.
Citation: Ricci KB, Rushing AP, Ingraham AM . The association between self-declared acute care surgery services and operating room access: results from a national survey. J Trauma Acute Care Surg 2019 Oct;87(4):898-906. doi: 10.1097/ta.0000000000002394..
Keywords: Surgery, Emergency Department, Access to Care
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.
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.
Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Daniel VT, Rushing AP, Ingraham AM
Association between operating room access and mortality for life-threatening general surgery emergencies.
Few diseases truly require emergency surgery today. In this study, the authors investigated the relationship between access to operating room (OR) and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. The investigators concluded that round-the-clock availability of personnel, specifically emergency general surgeons and recovery room nurses, is associated with decreased mortality.
Citation: Daniel VT, Rushing AP, Ingraham AM . Association between operating room access and mortality for life-threatening general surgery emergencies. J Trauma Acute Care Surg 2019 Jul;87(1):35-42. doi: 10.1097/ta.0000000000002267..
Keywords: Access to Care, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Surgery
Symer MM, Abelson JS, Yeo L
Barriers to regionalized surgical care: public perspective survey and geospatial analysis.
A cross-sectional telephone survey was performed as part of the Cornell National Social Survey. Participants had an average age of 50 and were 48.9% female. Almost half were unwilling to travel 5 hours or more to get regionalized care. Participants who were aged 70 or more had a decreased willingness to travel a perceived 30 minutes or more to a center. The higher the income, the more willingness to travel increased distances. Major perceived barriers were transportation, life disruption, social support, income levels, poor health and remoteness.
Citation: Symer MM, Abelson JS, Yeo L . Barriers to regionalized surgical care: public perspective survey and geospatial analysis. Ann Surg 2019 Jan;269(1):73-78. doi: 10.1097/sla.0000000000002556..
Keywords: Surgery, Access to Care, Healthcare Delivery
Smith AB, Meyer AM, Meng K
The relationship of travel distance with cystectomy access and outcomes.
The objectives of this study was to evaluate the effect of differential distance on cystectomy receipt among patients with muscle-invasive bladder cancer (MIBC) and investigate the association between travel distance and cystectomy outcomes such as readmission. The investigators found that the additional distance needed to reach a cystectomy provider did not predict receipt of surgery for MIBC. Furthermore, travel distance from cystectomy provider was not a significant predictor for subsequent readmission after cystectomy and did not affect overall survival.
Citation: Smith AB, Meyer AM, Meng K . The relationship of travel distance with cystectomy access and outcomes. Urol Oncol 2018 Jun;36(6):308.e1-08.e9. doi: 10.1016/j.urolonc.2018.03.005..
Keywords: Access to Care, Cancer, Hospital Readmissions, Outcomes, Surgery
Likosky DS, Sukul D, Seth M
Association between Medicaid expansion and cardiovascular interventions in Michigan.
This study evaluated Michigan’s Medicaid expansion as it relates to access and outcomes for 7,558 coronary artery bypass grafting operations at 33 hospitals and 45,183 percutaneous coronary interventions at 47 hospitals. Most of the change in access to revascularization occurred within the first quarter following expansion. Michigan’s Medicaid expansion was associated with changes in the demographic of those using specialty cardiovascular services (i.e., reduction in uninsured patients undergoing coronary rrevascularization).
Citation: Likosky DS, Sukul D, Seth M . Association between Medicaid expansion and cardiovascular interventions in Michigan. J Am Coll Cardiol 2018 Mar 6;71(9):1050-51. doi: 10.1016/j.jacc.2017.12.044.
Keywords: Access to Care, Cardiovascular Conditions, Heart Disease and Health, Surgery, Uninsured
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.
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
Zhang W, Lyman S, Boutin-Foster C
Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty.
The researchers sought to study racial disparities in the utilization of total knee arthroplasty (TKA), the use of high-volume hospitals, and TKA outcomes, including mortality and complications, using all-payer databases. They found that minorities had lower rates of TKA utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics.
Citation: Zhang W, Lyman S, Boutin-Foster C . Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am 2016 Aug 3;98(15):1243-52. doi: 10.2106/jbjs.15.01009.
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial / Ethnic Minorities, Healthcare Utilization, Surgery, Access to Care
Suskind AM, Zhang Y, Dunn RL
Understanding the diffusion of ambulatory surgery centers.
The objective of this study was to understand potential facilitators and/or barriers to the introduction of freestanding ambulatory surgical centers (ASCs) in the United States. It found that ASCs were more likely to open in hospital service areas that were urban, had higher per capita income, and less competition for outpatient surgery.
AHRQ-funded; HS020927; HS018726.
Citation: Suskind AM, Zhang Y, Dunn RL . Understanding the diffusion of ambulatory surgery centers. Surg Innov 2015 Jun;22(3):257-65. doi: 10.1177/1553350614546004..
Keywords: Ambulatory Care and Surgery, Access to Care, Surgery, Value, Social Determinants of Health
Boss EF, Benke JR, Tunkel DE
Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing.
The purpose of this study was (1) to evaluate receipt and timing of polysomnography (PSG) in relation to ultimate surgical therapy with adenotonsillectomy for children undergoing evaluation for sleep-disordered breathing and (2) to evaluate differences based on socio-economic status. It found that referral for PSG resulted in significant loss to follow-up for all children and delayed definitive surgical treatment for children with public insurance.
Citation: Boss EF, Benke JR, Tunkel DE . Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing. JAMA Otolaryngol Head Neck Surg 2015 Feb;141(2):106-11. doi: 10.1001/jamaoto.2014.3085..
Keywords: Social Determinants of Health, Surgery, Sleep Apnea, Access to Care, Health Insurance
Dy CY, Marx RG, Ghomrawi HM
The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty.
Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, the authors found that the complication risk was higher if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks, but patients from vulnerable groups were less likely to utilize these patterns.
Citation: Dy CY, Marx RG, Ghomrawi HM . The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty. J Arthroplasty 2015 Jan;30(1):1-6. doi: 10.1016/j.arth.2014.08.017.
Keywords: Access to Care, Disparities, Healthcare Delivery, Orthopedics, Surgery
Aliu O, Auger KA, Sun GH
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, the study investigators examined whether Medicaid expansion increased access to common musculoskeletal procedures for Medicaid beneficiaries. They concluded that Medicaid expansion in NY State significantly improved access to common musculoskeletal procedures for Medicaid beneficiaries.
Citation: Aliu O, Auger KA, Sun GH . The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care. Med Care 2014 Sep;52(9):790-5. doi: 10.1097/mlr.0000000000000175..
Keywords: Access to Care, Policy, Medicaid, Surgery