• Annals of surgery · May 2023

    Health System Structure: An Opportunity To Address Structural Racism And Discrimination.

    • Ezra S Brooks, Catherine L Mavroudis, Jason Tong, Christopher J Wirtalla, Ari Friedman, and Rachel R Kelz.
    • Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
    • Ann. Surg. 2023 May 1; 277 (5): 854858854-858.

    ObjectiveTo examine the role of hub-and-spoke systems as a factor in structural racism and discrimination.BackgroundHealth systems are often organized in a "hub-and-spoke" manner to centralize complex surgical care to 1 high-volume hospital. Although the surgical health care disparities are well described across health care systems, it is not known how they seem across a single system's hospitals.MethodsAdult patients who underwent 1 of 10 general surgery operations in 12 geographically diverse states (2016-2018) were identified using the Healthcare Cost and Utilization Project's State Inpatient Databases. System status was assigned using the American Hospital Association dataset. Hub designation was assigned in 2 ways: (1) the hospital performing the most complex operations (general hub) or (2) the hospital performing the most of each specific operation (procedure-specific hub). Independent multivariable logistic regression was used to evaluate the risk-adjusted odds of treatment at hubs by race and ethnicity.ResultsWe identified 122,236 patients across 133 hospitals in 43 systems. Most patients were White (73.4%), 14.2% were Black, and 12.4% Hispanic. A smaller proportion of Black and Hispanic patient underwent operations at general hubs compared with White patients (B: 59.6% H: 52.0% W: 62.0%, P <0.001). After adjustment, Black and Hispanic patients were less likely to receive care at hub hospitals relative to White patients for common and complex operations (general hub B: odds ratio: 0.88 CI, 0.85, 0.91 H: OR: 0.82 CI, 0.79, 0.85).ConclusionsWhen White, Black, and Hispanic patients seek care at hospital systems, Black and Hispanic patients are less likely to receive treatment at hub hospitals. Given the published advantages of high-volume care, this new finding may highlight an opportunity in the pursuit of health equity.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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