Regional Differences in Access to Emergency Care in the US 5.23.08
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The document analyzes regional differences in access to emergency care in the United States. It finds that while the majority of the US population can access an emergency department (ED) within 30 minutes, access varies significantly by region and ED characteristics. Rural areas have lower access rates to all types of EDs compared to urban and suburban areas. The type of ED that has the best access within 30 minutes is any ED, followed by higher volume EDs, with teaching hospitals having the lowest access rates within 30 minutes. There are opportunities to improve emergency care through understanding ED capabilities, referral networks, and the relationship between access and health outcomes.
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![Regional Differences in Access to Emergency Care in the United States BG Carr, MD MA 1 , CC Branas, PhD 1 , JP Metlay, MD PhD 1 , AF Sullivan, MS MPH 2 , & CA Camargo, MD DrPH 2 1 University of Pennsylvania School of Medicine, 2 Massachusetts General Hospital Figure 1: Access to any emergency department* Figure 2. Access to a higher volume emergency department within 30 minutes *, ** * Estimates allow vehicles to cross state lines ** At least 1 patient/hour over the year (8,760 visits/year) Table 1. % Population Access by type of ED by Region Figure 3: Percent access to a higher volume ED in 30 minutes by percent rural ,[object Object],[object Object],Background ,[object Object],Objective ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],Policy Implications Any Emergency Department Higher Volume Emergency Department Council of Teaching Hospitals Emergency Department 30 min 60 min 30 min 60 min 30 min 60 min Northeast 76 99.5 76 99.1 31 70 New England 72 99.5 71 99 25 59 Middle Atlantic 78 99.5 77 99.1 33 70 Midwest 70 99 65 92 17 48 East North Central 72 99.2 68 96 19 52 West North Central 66 98 56 83 13 40 South 68 99 65 96 12 36 South Atlantic 68 99.1 67 99 14 42 East South Central 63 99.5 58 97 8 26 West South Central 71 98 65 93 9 37 West 71 97 68 94 9 37 Mountain 66 95 61 88 8 32 Pacific 74 98 72 97 10 40 Figures](https://image.slidesharecdn.com/carrbrendan-regionaldifferencesinaccesstoemergencycareintheus-5-23-08-100818143925-phpapp02/85/Regional-Differences-in-Access-to-Emergency-Care-in-the-US-5-23-08-1-320.jpg)
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rectum. Most begin as an adenomatous polyp and grow into the wall of the
colon or rectum before metastasizing by invading tissues or structures, the
bloodstream, or the lymphatic system. About 95% of CRCs are adenocarci-
nomas (American Cancer Society [ACS], 2017b). The ACS (2017a) projected
that 135,430 people would be diagnosed with CRC in the United States in
2017. Although the CRC death rate has been dropping for the past 20 years,
the ACS still estimated 50,260 CRC-related deaths during 2017 (ACS, 2017a).
The Centers for Disease Control and Prevention ([CDC], 2017) recom-
mends screening for precancerous polyps for anyone aged 50 years or older.
Although early detection and diagnosis greatly affect survival rates, only about
half of the U.S. population participates in screening (ACS, 2017a). A fecal
immunochemical test (FIT) is a noninvasive test used to detect blood in the
stool that cannot be seen with the human eye (Tresca, 2017). People at home
use the FIT kit by obtaining a sample of the stool with one of the FIT kit sticks
and inserting the sample back in the vial. The FIT kits are then either mailed or
hand-delivered to a laboratory for blood detection, most specifically from the
lower gastrointestinal tract (Tresca, 2017).
The State Cancer Profiles report by the National Cancer Institute (NCI)
and CDC (2014) ranked Kentucky seventh for mortality, with a death rate
of 17.6 per 100,000 compared to a national rate of 15.1. At the time of this
project, the CRC death rate in Hopkins County, Kentucky, was 14.1 per
100,000, one of the highest in the state. The death rate in Kentucky has been
trending downward over time from 25.8 in 1982 to 17.6 in 2013 (NCI and CDC,
2014). Incidence and death rates are depicted in Figure 1.
In 2008, the Kentucky Colon Cancer Screening Program (KCCSP) was
formed with the passage of Kentucky Regulatory Statute 214.540 to increase
CRC screening, reduce morbidity and mortality from CRC, and reduce costs
for CRC treatment. The goal of the KCCSP is to increase the number of CRC
screenings in Kentucky, using 75% FIT kits and 25% colonoscopies (Justia,
2011).
About 39% of CRCs are diagnosed at the local stage or confined to the
primary site, but 56% have already spread to regional lymph nodes or have
metastasized. If diagnosed at the localized stage, there is a 90% five-year rel-
ative survival rate, but this decreases to 14% when the cancer is in distant
sites. The survival rate for regional sites is 71% and 35% for unstaged. NCI
(2017a) projects that early detection of CRC could improve survival rates by
about 60%.
KEYWORDS
colorectal cancer screening; human carin ...
Aboriginal Patterns of Cancer Care Project Breast Cancer paper BMCCancer 1471...
Aboriginal women in New South Wales, Australia have lower rates of survival from breast cancer than non-Aboriginal women. Aboriginal women were less likely to receive surgical treatment for their breast cancer and were more likely to have other health issues. After accounting for differences in factors like age, disease stage at diagnosis, surgical treatment, and health issues, Aboriginal women still had a 30% higher risk of death from breast cancer. Improving access to surgical treatment and reducing health issues may help increase breast cancer survival rates for Aboriginal women.
Annual Arizona Conference for Tribal BCCEDP Collaboration, Flagstaff, AZ
Here are the key points the researchers would need to address in their proposal:
Clinical Genomics and Medicine
September presentation at Vanderbilt highlighting big data, cancer genomics data commons, NCI cloud pilots
Annals of Translational Medicine & Epidemiology
Annals of Translational Medicine & Epidemiology is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of biomedical and public health research that aims to improve the health of individuals and the community by "translating" findings into diagnostic tools, medicines, procedures, policies and education and occurrences of diseases in people.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Annals of Translational Medicine & Epidemiology accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all the related aspects of "translating" findings into diagnostic tools, medicines, procedures, policies and education and occurrences of diseases in people.
Cancer summitt 2020 buffalo aug 2011
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No sólo de especialistas médicos vive el hombre
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- They found that higher ratios of primary care physicians were associated with lower mortality rates for total, heart disease, and cancer mortality. However, higher ratios of specialist physicians showed no improvement or even higher mortality rates.
- These findings suggest that simply increasing the supply of specialists will not necessarily improve population health outcomes and could worsen health disparities.
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A telehospitalist is a physician who provides care for hospitalized patients at a distance using telemedicine. As the US faces a projected physician shortage, telemedicine and utilizing advanced practice clinicians can help address gaps, especially in rural areas with limited access to care. The document describes a telehospitalist program launched in Oklahoma in 2014 connecting physicians in Oklahoma City to patients in rural hospitals over 60 miles away. The program has had over 3,900 telemedicine visits for more than 1,100 patients. Key lessons learned include the importance of local buy-in, flexibility, and focusing on patient-centered care.
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The document summarizes research on variations in medical practice and healthcare utilization in different geographic regions. It discusses studies in Vermont and Maine that found wide variations in tonsillectomy and hysterectomy rates that did not correlate with patient characteristics or health status. The Dartmouth Atlas Project also found significant unwarranted variations across hospital referral regions in procedures, spending, and end-of-life care intensity. Areas with more healthcare resources generally had higher utilization and spending but not better outcomes.
Yu11134
This study analyzed data on 68,686 men diagnosed with prostate cancer in New South Wales, Australia between 1982-2007 to investigate geographic differences in survival rates. The key findings were:
1) Overall 10-year survival rates increased over time but men living outside major cities had higher risks of death even after adjusting for clinical factors.
2) Men in inner regional and rural areas were less likely to have localized disease and more likely to have unknown stage at diagnosis compared to men in cities.
3) Socioeconomic status was also a significant prognostic factor, with men from disadvantaged areas having higher mortality risks than men from affluent areas.
4) Despite increasing awareness and policies aimed at reducing dispar
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American Journal of Anesthesia & Clinical Research
American Journal of Anesthesia & Clinical Research
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