Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals

Eslami, Mohammad H.; Rybin, Denis; Doros, Gheorghe; Farber, Alik

doi:10.1016/j.jvs.2014.08.055

Cited by 30 publications

(14 citation statements)

References 24 publications

(34 reference statements)

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“…Our findings of higher in-hospital mortality, across all cases and for several procedures individually, contrasts with prior reports for patients with head and neck cancer 11 and those undergoing vascular procedures 5 . Likewise, data on cost estimates for specialty care at safety net facilities have been mixed.…”

Section: Discussioncontrasting

confidence: 99%

“…Likewise, data on cost estimates for specialty care at safety net facilities have been mixed. Namely, while one analysis demonstrated higher costs for vascular procedures at SNHs 5 , others have shown—like us—that costs are lower for inpatient surgery performed at safety net facilities 4 . Adding to this arguably mixed picture of specialty care at safety net hospitals, our findings suggest that, for some procedures, urologic care delivered to the often-vulnerable populations served by SNHs is associated with less favorable outcomes often at a similar price.…”

Section: Discussionmentioning

confidence: 65%

“…However, while certain aspects of specialty care in safety net facilities have been studied, little is known about the utilization and outcomes of urologic care in SNHs and how it compares to that provided in non-safety net facilities 5,6 . An awareness of such differences is important to anticipating, and perhaps even mitigating, the impact of ACA-directed funding changes for these already resource-poor facilities.…”

Section: Introductionmentioning

confidence: 99%

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Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Herrel

Miller

2015

Journal of Urology

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Purpose Because proposed funding cuts in the Affordable Care Act may impact care for urological patients at safety-net hospitals, we examined utilization, outcomes and costs of inpatient urological surgery at safety-net vs non-safety-net facilities prior to healthcare reform. Materials and Methods Using the Nationwide Inpatient Sample, we performed a retrospective cohort study of patients undergoing inpatient urological surgeries from 2007 through 2011. We defined the “safety-net burden” of each hospital based on the proportion of Medicaid and self-pay discharges. We examined the distribution of urologic procedures performed, and compared in-hospital mortality, prolonged length of stay and costs in the highest quartile of burden (safety-net) vs lowest quartile (non-safety-net). Results The distribution of urological procedures differs by safety-net status, with less benign prostate (9.1% safety-net vs 11.4% non-safety-net) and major cancer surgery (26.9% vs 34.3%), and more reconstructive surgery (8.1% vs 5.5%) at safety-net facilities (p-values<0.001). Higher mortality at safety-net hospitals was seen for nephrectomy (OR 1.68, 95% CI 1.15–2.45) and TURP (OR 2.17, 95% CI 1.22–3.87). Patients in safety-net hospitals demonstrated greater prolonged LOS after endoscopic stone surgery (OR 1.20, 95% CI 1.01–1.41). Costs were similar across procedures except radical prostatectomy and cystectomy, where the average admission was more expensive at non-safety-net facilities (prostatectomy $9,610 vs $11,457 and cystectomy $24,048 vs $27,875, p-values <0.02). Conclusions Reductions in funding to safety-net hospitals with healthcare reform could adversely impact access to care for patients with a broad range of urological conditions, potentially exacerbating existing disparities for vulnerable populations served by these facilities.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Herrel

Miller

2015

Journal of Urology

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“…18 Medicaid patients often present later, and with more advanced disease, than patients with private insurance. 19 In contrast, Baicker et al compared adults who benefited from Oregon's lottery-based Medicaid expansion in 2008, to adults who did not. 20 Patients in the Medicaid expansion had improved preventive screening and decreased catastrophic out-of-pocket medical expenses compared with uninsured patients who did not benefit from the Medicaid expansion.…”

Section: Plastic and Reconstructive Surgery • February 2016mentioning

confidence: 99%

Surgeon Reimbursements in Maxillofacial Trauma Surgery

Khansa

Pearson

2016

Plastic and Reconstructive Surgery

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“…The consequences of poor access to ambulatory specialty services within public health care systems, in particular surgical, include increased risk of requiring urgent or emergent surgery, longer lengths of hospitalizations, and decreased likelihood of receiving follow-up care [18–20]. …”

Section: Introductionmentioning

confidence: 99%

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Ulloa

Russell

Chen

et al. 2017

BMC Health Serv Res

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BackgroundElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).MethodsRetrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.ResultsIn 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.ConclusionEconsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

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Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals

Cited by 30 publications

References 24 publications

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Surgeon Reimbursements in Maxillofacial Trauma Surgery

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

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