Developing an Index of Surgical Underservice
The objective of this research initiative is to identify geographic patterns in the availability of surgical services and examine factors related to supply. Analyses will be used to develop a method for modeling per-capita surgical need based on county-level characteristics (for example, population, health care infrastructure) and then analyzing and characterizing the adequacy of current surgical supply with respect to the estimate of need.
Analysis of Trends in Utilization of Surgical Services in North Carolina and the U.S. Between 1997–2008
Numerous studies, particularly those produced by the Dartmouth Atlas workgroup, have demonstrated variation in the provision of health care services in the U.S. The objective of this study is to examine longitudinal and geographic variation in high-volume procedures—orthopaedic, cardiovascular, and oncology—in North Carolina between 1997 and 2008.The study seeks to estimate the effect of technological innovations; changes in practice patterns; payment policy changes; and patient, provider, and area population characteristics on utilization of services. Bivariate and multivariate (including hierarchical and spatial regression) techniques will be employed to estimate variation in procedure rates.
Variation in Outcomes for Surgery Sensitive Conditions Associated with Access to Hospital-Based Surgical Services
This study aims to examine the effect of the availability of local general surgical expertise on patient outcomes for select surgery-sensitive disease processes. Inpatient hospital discharge data for adults diagnosed with one of six surgery-sensitive—appendicitis, peritonitis, nonreducible hernia, bowel obstruction, ruptured spleen, and necrotizing fasciitis—or two reference conditions—cholecystitis and non-obstructed hernia—will be analyzed with respect to length of stay, stage of illness, and diagnoses for complications. Logistic regression analysis will be conducted to estimate the effect of access to a surgeon on several outcome variables for surgery-sensitive and reference conditions.
Assessing the Sustainability of Rural Surgery
This study will examine, through a Web-based survey of rural surgeons and hospital administrators, the scope of care provided in rural areas, factors affecting physician and facility decisions to maintain a rural surgical practice, and the challenges unique to rural surgery programs.
The Surgery Atlas, through the use of maps and charts, will provide a picture of the geographic distribution of providers (institutions and individuals). Maps will present all 50 U.S. states; while charts and graphs will summarize regional and state workforce trends. When appropriate, data may also be presented using Hospital Referral Regions or Health Care Service Areas as constructed by the Dartmouth Atlas. This atlas will be a Web-based product, which offers unique interactivity that allows users to zoom into a particular geographic area such as a state or Census region.