A Network Science Approach to Emergency Surgical Care for Older Adults: Evaluating the Impact of Health System Structure on Outcomes and Access to Care
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Modified Project Summary/Abstract Section Each year, over 3 million patients in the United States are admitted with Emergency General Surgery (EGS) conditions, which are a group of acute non-traumatic thoracic, abdominal and soft tissue conditions that require urgent surgical evaluation and management. Older adults represent approximately half of all EGS patients, who experience variable rates of poor outcomes, with 1-year mortality that approaches 30% and over half readmitted to hospital within 30-days. A central challenge in EGS care delivery is that hospitals with emergency surgical capabilities are distributed differently across the United States, leading to wide variance in availability of care that increases mortality and affects rural patients and communities that experience persistent differences in health status. To develop effective health systems for EGS, it is critical to understand geographic patterns of hospital utilization and how health system structure impacts patient outcomes. This proposal addresses these knowledge gaps by applying network-based community detection methods to identify and characterize naturally occurring geographic regions of EGS care and examine how hospital networks within these regions contribute to differences in availability of care and outcomes for older adults. Our overarching hypothesis is that the structure and organization of regional networks influences availability of care and contributes to outcomes and clinically meaningful differences for specific subpopulations. The Specific Aims are: 1) Using national Medicare claims data and network science methods, we will identify and characterize empiric geographic health referral regions across the US for older adults receiving EGS care. We will quantify variation in network structure and organization, as well as availability and receipt of care through ED presentation and interhospital transfer. 2) Test the association between network characteristics and clinical outcomes for older EGS patients. We will use multi-level geographically weighted regression modeling to examine the contribution of network organization to acute in-hospital outcomes and post-discharge care utilization. 3) Assess network contributions to differences in availability, receipt of care and outcomes among populations that experience elevated risk of poor outcomes. Impact: Using innovative network science methods, this work will advance ongoing efforts to develop effective EGS systems for older adults by increasing our knowledge of how health system structure contributes to patient outcomes. It will have an immediate impact by defining national referral regions for surgical care, informing the ongoing development of regionalized EGS programs, and offers novel methods to monitor changes in availability of emergency surgical care.
