tween estimated and observed distance for both methods (zip code + 4, t 5443 , −19.9; population-weighted zip code, t 5443 , −21.9; P < .001 for both). For the zip code + 4 estimate, the mean error was −2.4 (95% CI, −2.6 to −2.1), and the absolute mean error was 6.0 (95% CI, 5.8-6.2) miles. For populationweighted estimates, the mean error was −1.8 (95% CI, −1.9 to −1.8), and the absolute mean error was 4.6 (95% CI, 4.5-4.6) miles. Absolute error and observed driving distances were moderately correlated for both zip code + 4 and populationweighted estimates (r = 0.31 and r = 0.27, respectively).Discussion | The geographic information system-based estimates of ambulance driving distance based on residential zip codes can produce reasonable estimates of ambulance miles driven. These estimates can support efforts to control for the duration of the prehospital interval in injury outcomes studies using administrative data, including Medicare or other insurance data sets.Limitations of this study include use of primary and secondary road networks, which could potentially result in disregarding shorter travel paths in regions with fewer such roads. The resolution of 1 pixel per square mile could introduce noticeable rounding errors when zip code-based centroids were near a medical facility or when traveling in an urban environment, potentially underestimating the correlation between estimated and observed distance.However, these reasonable estimates may also be useful when examining prehospital triage decisions. The differential distance between the nearest hospital and the nearest trauma center is a crucial consideration for emergency medical service professionals.
Objective: This study analyzes patients’ preferences around disclosure in cases of IMED. Background: Patients prefer that physicians disclose their self-discovered medical errors, and disclosure expectations and practices have changed accordingly. Patient preferences about disclosure when physicians discover another provider's error are unknown. Methods: We conducted telephone interviews beyond thematic saturation (N = 30) from January to March 2018 with patient volunteers in Michigan. Participants responded to 2 medical error vignettes, the first involving a single physician discovering their own error, and the second involving an IMED scenario. Interviews were conducted concurrently with thematic coding, coded independently by 2 investigators, and discussed until consensus was reached. Analysis proceeded after the inductive and comparative approach of interpretive description. Results: Patients considered IMED essentially equivalent to self-discovered errors, and strongly preferred disclosure in both scenarios. Patients preferred disclosure for a variety of reasons, most commonly describing an inherent value in knowing about their own health, a belief that physicians should practice honesty and transparency, and a desire to participate in future care in an informed manner. Patients said they would likely take certain actions after disclosure of another physician's error, ranging from confronting the responsible physician to changing providers to pursuing legal action, with the latter being only in cases of irreversible and debilitating errors. Conclusions: This study explores a new domain within the field of error disclosure, concluding that patients preferred disclosure of errors in cases of IMED. Overall, these findings provide motivation to devise systems-level solutions to enable and facilitate IMED disclosure.
Cancer (NAPRC) promotes multidisciplinary care to improve oncologic outcomes in rectal cancer. However, accreditation requirements may be difficult to achieve for the lowest-performing institutions. Thus, it is unknown whether the NAPRC will motivate care improvement in these settings or widen disparities. OBJECTIVES To characterize hospitals' readiness for accreditation and identify differences in the patients cared for in hospitals most and least prepared for accreditation. DESIGN, SETTING, AND PARTICIPANTS A total of 1315 American College of Surgeons Commission on Cancer-accredited hospitals in the National Cancer Database from January 1, 2011, to December 31, 2015, were sorted into 4 cohorts, organized by high vs low volume and adherence to process standards, and patient and hospital characteristics and oncologic outcomes were compared. The patients included those who underwent surgical resection with curative intent for rectal adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma. Data analysis was performed from November 2017 to January 2018. EXPOSURES Hospitals' readiness for accreditation, as determined by their annual resection volume and adherence to 5 available NAPRC process standards. MAIN OUTCOMES AND MEASURES Hospital characteristics, patient sociodemographic characteristics, and 5-year survival by hospital. RESULTS Among the 1315 included hospitals, 38 (2.9%) met proposed thresholds for all 5 NAPRC process standards and 220 (16.7%) met the threshold on 4 standards. High-volume hospitals (Ն20 resections per year) tended to be academic institutions (67 of 104 [64.4%] vs 159 of 1211 [13.1%]; P = .001), whereas low-volume hospitals (<20 resections per year) tended to be comprehensive community cancer programs (530 of 1211 [43.8%] vs 28 of 104 [26.9%]; P = .001). Patients in low-volume hospitals were more likely to be older (11 429 of 28 076 [40.7%] vs 4339 of 12 148 [35.7%]; P < .001) and have public insurance (13 054 of 28 076 [46.5%] vs 4905 of 12 148 [40.4%]; P < .001). Low-adherence hospitals were more likely to care for black and Hispanic patients (1980 of 19 577 [17.2%] vs 3554 of 20 647 [10.1%]; P < .001). On multivariable Cox proportional hazards model regression, high-volume hospitals had better 5-year survival outcomes than low-volume hospitals (hazard ratio, 0.99; 95% CI, 0.99-1.00; P < .001), but there was no significant survival difference by hospital process standard adherence. CONCLUSIONS AND RELEVANCE Hospitals least likely to receive NAPRC accreditation tended to be community institutions with worse survival outcomes, serving patients at a lower socioeconomic position. To possibly avoid exacerbating disparities in access to high-quality rectal cancer care, the NAPRC study findings suggest enabling access for patients with socioeconomic disadvantage or engaging in quality improvement for hospitals not yet achieving accreditation benchmarks.
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