Travel Time as an Indicator of Poor Access to Care in Surgical Emergencies.

Importance: Timely access to care is a key metric for health care systems and is particularly important in conditions that acutely worsen with delays in care, including surgical emergencies. However, the association between travel time to emergency care and risk for complex presentation is poorly understood.

Objective: To evaluate the impact of travel time on disease complexity at presentation among people with emergency general surgery conditions and to evaluate whether travel time was associated with clinical outcomes and measures of increased health resource utilization.

Scoping Review: Association of Inpatient Hospital Design Features With Patients' Clinical Outcomes.

To identify associations between inpatient hospital design features and empirical patient clinical outcomes as well as changes over time. A growing body of literature has emerged evaluating the association of hospital design features with measurable clinical outcomes during inpatient hospital admissions. However, there has been limited effort to evaluate the scope and quality of studies examining individual, inpatient hospital design features on empirical patient clinical outcomes.

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

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

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

Over- and underreporting of prices: most hospitals are not compliant with the Hospital Price Transparency Rule.

Concern has been raised about the effectiveness of the Hospital Price Transparency Rule to facilitate a clear understanding of health care prices due to poor reporting by hospitals. However, the relationship between what services the hospital provides and what prices they report is not clear. We assessed reported prices in the Turquoise Health database and compared them at the hospital level with the CMS Provider of Services File to identify if a shoppable service was provided at a hospital.

Social Capital and Surgery Access Among Medicare Beneficiaries.

Objective: To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels.

Background: Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.

Association of Hospital System Affiliation with Spending and Postoperative Outcomes: A Longitudinal Study of Hospital Mergers And Acquisitions From 2010 To 2018.

Objective: To determine whether hospital system affiliation was associated with changes in surgical episode spending or postoperative outcomes.

Background: Over 70% of US hospitals are now part of a hospital system. The presumed benefits of hospital consolidation include concentrating volume and expertise, care integration, and investment in quality improvement.

Variation in Postoperative Outcomes Across Federally Designated Hospital Star Ratings.

Importance: Despite widespread use to guide patients to hospitals providing the best care, it remains unknown whether Centers for Medicare & Medicaid Services (CMS) hospital star ratings are a reliable measure of hospital surgical quality.

Objective: To examine the CMS hospital star ratings and hospital surgical quality measured by 30-day postoperative mortality, serious complications, and readmission rates for Medicare beneficiaries undergoing colectomy, coronary artery bypass graft, cholecystectomy, appendectomy, and incisional hernia repair.

Design, Setting, And Participants: This cohort study evaluated 100% Medicare administrative claims for nonfederal acute care hospitals with a CMS hospital star rating for calendar years 2014-2018.

Unplanned Surgery in Dually Eligible Beneficiaries for Conditions that Should Be Treated Electively.

Objective: To evaluate the rate of unplanned surgery among dually eligible beneficiaries for surgical conditions that should be treated electively.

Summary Background Data: Access-sensitive surgical conditions (e.g.

Reported Prices for High-Volume Hand Surgery in the Era of Price Transparency: Implications for Future Policy Iterations.

Background: In 2021, the United States enacted a law requiring hospitals to report prices for health care services. Across several health care services, poor compliance and wide variation in pricing was found. This study was performed to investigate variation in reporting and listed prices by hospital features for high-volume hand procedures, including carpal tunnel release, trigger finger release, de Quervain tenosynovitis release, and carpometacarpal arthroplasty.

Health Insurance Status and Unplanned Surgery for Access-Sensitive Surgical Conditions.

Importance: Access-sensitive surgical conditions, such as abdominal aortic aneurysm, ventral hernia, and colon cancer, are ideally treated with elective surgery, but when left untreated have a natural history requiring an unplanned operation. Patients' health insurance status may be a barrier to receiving timely elective care, which may be associated with higher rates of unplanned surgery and worse outcomes.

Objective: To evaluate the association between patients' insurance status and rates of unplanned surgery for these 3 access-sensitive surgical conditions and postoperative outcomes.

Optimizing care delivery in expanding health systems: Views from clinical leaders.

Introduction: In response to intense market pressures, many hospitals have consolidated into systems. However, evidence suggests that consolidation has not led to the improvements in clinical quality promised by proponents of mergers. The challenges to delivering care within expanding health systems and the opportunities posed to surgical leaders remains largely unexplored.

Understanding the impacts of rural hospital closures: A scoping review.

Purpose: Rural hospitals are closing at unprecedented rates, with hundreds more at risk of closure in the coming 2 years. Multiple federal policies are being developed and implemented without a salient understanding of the emerging literature evaluating rural hospital closures and its impacts. We conducted a scoping review to understand the impacts of rural hospital closure to inform ongoing policy debates and research.

Rate of Emergency Lower Extremity Amputations in the United States Among Medicare Beneficiaries.

Objective: To determine the rate of emergency versus elective lower extremity amputations in the United States.

Background: Lower extremity amputation is a common endpoint for patients with poorly controlled diabetes and multilevel peripheral vascular disease. Although the procedure is ideally performed electively, patients with limited access may present later and require an emergency operation.

How Blackouts during Heat Waves Amplify Mortality and Morbidity Risk.

The recent concurrence of electrical grid failure events in time with extreme temperatures is compounding the population health risks of extreme weather episodes. Here, we combine simulated heat exposure data during historical heat wave events in three large U.S.

The Variable Impact of Clinical Risk-Adjustment Models to Evaluate Hospital Design.

Objectives: To identify the impact of clinical risk adjustment models for evaluating pain medication consumption differences between private rooms and a multibed ward.

Background: Views of nature are reported to reduce anxiety and pain for patients. This often leads to prioritizing large windows with views for patient rooms; however, it is not clear how other factors influencing pain (e.

Point of Decision Design to Address Adolescent Overweight and Obesity.

Objectives: This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity.

Background: Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study.

Association Between California's State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery.

Importance: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies.

Objective: To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents.

High-risk surgery among Medicare beneficiaries living in health professional shortage areas.

Purpose: Americans who reside in health professional shortage areas currently have less than half of the needed physician workforce. While the shortage designation has been associated with poor outcomes for chronic medical conditions, far less is known about outcomes after high-risk surgical procedures.

Methods: We performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018.

Association of Hospital Quality and Neighborhood Deprivation With Mortality After Inpatient Surgery Among Medicare Beneficiaries.

Importance: Although the hospital at which a patient is treated is a known source of variation in mortality after inpatient surgery, far less is known about how the neighborhoods from which patients come may also contribute.

Objective: To compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and hospital quality where they received care.

Design, Setting, And Participants: This cross-sectional study examined outcomes among Medicare beneficiaries undergoing 1 of 5 common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018.

Association of Health Professional Shortage Area Hospital Designation With Surgical Outcomes and Expenditures Among Medicare Beneficiaries.

Objective: To compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries.

Background: More than a quarter of Americans live in federally designated Health Professional Shortage Areas. Although there is growing concern that medical outcomes may be worse, far less is known about hospitals providing surgical care in these areas.