A Surgical Desirability of Outcome Ranking (DOOR) Reveals Complex Relationships Between Race/Ethnicity, Insurance Type, and Neighborhood Deprivation
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved..
OBJECTIVE: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health.
BACKGROUND: Studies focused on single or binary composite outcomes may not detect health disparities.
METHODS: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO).
RESULTS: Patients living in highly deprived neighborhoods (ADI>85) had higher odds of PASC [adjusted odds ratio (aOR)=1.13, CI=1.02-1.25, P <0.001] and urgent/emergent cases (aOR=1.23, CI=1.16-1.31, P <0.001). Increased odds of higher/less desirable DOOR scores were associated with patients identifying as Black versus White and on Medicare, Medicaid or Uninsured versus Private insurance. Patients with ADI>85 had lower odds of TO (aOR=0.91, CI=0.85-0.97, P =0.006) until adjusting for insurance. In contrast, patients with ADI>85 had increased odds of higher DOOR (aOR=1.07, CI=1.01-1.14, P <0.021) after adjusting for insurance but similar odds after adjusting for PASC and urgent/emergent cases.
CONCLUSIONS: DOOR revealed complex interactions between race/ethnicity, insurance type and neighborhood deprivation. ADI>85 was associated with higher odds of worse DOOR outcomes while TO failed to capture the effect of ADI. Our results suggest that presentation acuity is a critical determinant of worse outcomes in patients in highly deprived neighborhoods and without insurance. Including risk adjustment for living in deprived neighborhoods and urgent/emergent surgeries could improve the accuracy of quality metrics.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:279 |
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| Enthalten in: |
Annals of surgery - 279(2024), 2 vom: 01. Feb., Seite 246-257 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jacobs, Michael A [VerfasserIn] |
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| Anmerkungen: |
Date Completed 11.01.2024 Date Revised 18.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/SLA.0000000000005994 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM359514308 |
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| 100 | 1 | |a Jacobs, Michael A |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Surgical Desirability of Outcome Ranking (DOOR) Reveals Complex Relationships Between Race/Ethnicity, Insurance Type, and Neighborhood Deprivation |
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| 500 | |a Date Revised 18.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health | ||
| 520 | |a BACKGROUND: Studies focused on single or binary composite outcomes may not detect health disparities | ||
| 520 | |a METHODS: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO) | ||
| 520 | |a RESULTS: Patients living in highly deprived neighborhoods (ADI>85) had higher odds of PASC [adjusted odds ratio (aOR)=1.13, CI=1.02-1.25, P <0.001] and urgent/emergent cases (aOR=1.23, CI=1.16-1.31, P <0.001). Increased odds of higher/less desirable DOOR scores were associated with patients identifying as Black versus White and on Medicare, Medicaid or Uninsured versus Private insurance. Patients with ADI>85 had lower odds of TO (aOR=0.91, CI=0.85-0.97, P =0.006) until adjusting for insurance. In contrast, patients with ADI>85 had increased odds of higher DOOR (aOR=1.07, CI=1.01-1.14, P <0.021) after adjusting for insurance but similar odds after adjusting for PASC and urgent/emergent cases | ||
| 520 | |a CONCLUSIONS: DOOR revealed complex interactions between race/ethnicity, insurance type and neighborhood deprivation. ADI>85 was associated with higher odds of worse DOOR outcomes while TO failed to capture the effect of ADI. Our results suggest that presentation acuity is a critical determinant of worse outcomes in patients in highly deprived neighborhoods and without insurance. Including risk adjustment for living in deprived neighborhoods and urgent/emergent surgeries could improve the accuracy of quality metrics | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Schmidt, Susanne |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Daniel E |e verfasserin |4 aut | |
| 700 | 1 | |a Stitzenberg, Karyn B |e verfasserin |4 aut | |
| 700 | 1 | |a Kao, Lillian S |e verfasserin |4 aut | |
| 700 | 1 | |a Brimhall, Bradley B |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Chen-Pin |e verfasserin |4 aut | |
| 700 | 1 | |a Manuel, Laura S |e verfasserin |4 aut | |
| 700 | 1 | |a Su, Hoah-Der |e verfasserin |4 aut | |
| 700 | 1 | |a Silverstein, Jonathan C |e verfasserin |4 aut | |
| 700 | 1 | |a Shireman, Paula K |e verfasserin |4 aut | |
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