We demonstrate a low-cost model methodology for examining the representativeness of practice networks using independent data with minimum practice input.
W e congratulate Baxter and Chung on their article entitled "The Plastic Surgeon's Role in Health Equity Research and Policy" for highlighting this important issue. Although several aspects have particular relevance to the United States' health care system, it is important to note that the matter raised is not unique to the country.The Commonwealth Fund 2017 report ranked the United Kingdom's National Health Service (NHS) first overall in comparison to other developed countries' health systems, also ranking first for health care processes and equity. 1 Despite this world-leading ranking of a publicly funded universal health care system, health care disparities continue to exist, with similar issues as reported in the aforementioned article.Although financed through a centralized government, funding for individual procedures and services occurs though regional clinical commissioning groups. Despite being "based on local need," notable geographical variations occur in available procedures for patients. This was compounded by the NHS England's publication of a list of Procedures of Limited Clinical Value in 2018, 2 including Dupytren contracture release and carpal tunnel decompression. Funding for these procedures is required to be applied individually at a local level once a clinical threshold is met, risking creating a health care system based on an individual's postal address. This reduction in access may also disproportionally impact lower socioeconomic groups despite an increased prevalence in these conditions; a more deprived cohort has been shown to have a greater incidence of carpal tunnel syndrome with higher reported levels of functional impairment at presentation. 3 Within the United Kingdom, plastic surgery units are often organized as a "hub and spoke model" with specialized procedures provided at centralized units and more limited services undertaken at satellite establishments. This results in some patients being required to travel longer distances for specific services, such as autologous breast reconstruction. It has been previously reported that some women considering breast reconstruction had surgical options limited by a reluctance to travel to more distant centers, 4 whereas women living further than 30 minutes from a plastic surgery clinic were less likely to undergo bilateral breast reduction surgery. 5 Variation in method and timing of breast reconstruction dependent on ethnicity within the United Kingdom has also been noted, with women of Black or Asian ethnicity less likely to undergo immediate breast reconstruction post-mastectomy when compared with White women. 6 Such is the degree of variability and inequity within the UK health care system, the Getting It Right, First Time project was launched. The overall aim, initially launched in orthopedic surgery, is to reduce the degree of unwanted variability in the NHS. The initial pilot report highlighted widespread discrepancies in local practices throughout hospitals in the country, even among comparable patient groups, resulting in notable i...
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