当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS期刊下所有文献 > Affordable Care Act's Medicaid Expansion and Use of Regionalized Surgery at High-Volume Hospitals.

Affordable Care Act's Medicaid Expansion and Use of Regionalized Surgery at High-Volume Hospitals.

Abstract：

BACKGROUND:The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in use of regionalized surgery at high-volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the use of regionalized surgery at HVH among racial/ethnic minorities and low-income populations. STUDY DESIGN:Data from State Inpatient Databases (2012 to 2014), the American Hospital Association Annual Survey Database, and the Area Resource File from Health Resources and Services Administration, were used to examine 166,558 nonelderly (ages 18 to 64) adults at 468 hospitals, who underwent 1 of 4 regionalized surgical procedures in 3 expansion (KY, MD, NJ) and 2 nonexpansion states (NC, FL). Thresholds of HVH were defined using the top quintile of visits per year. Interrupted time series were performed to measure the impact of expansion on use rates of regionalized surgery at HVH overall, by race/ethnicity, and by income. RESULTS:Overall, ACA's expansion was not associated with accelerated use rates of regionalized surgical procedures at HVH (odds ratio [OR] 1.016, p = 0.297). Disparities in use of regionalized surgical procedures at HVH among ethnic/racial minorities and low-income populations were unchanged; minority vs white (OR 1.034 p = 0.100); low-income vs high-income (OR 1.034, p = 0.122). CONCLUSIONS:Early findings from ACA's Medicaid expansion revealed no impact on the use rates of regionalized surgery at HVH overall or on disparities among vulnerable populations. Although these results need ongoing evaluation, they highlight potential limitations in ACA's expansion in reducing disparities in use of regionalized surgical care.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

McDermott J,Zeymo A,Chan K,Ehsan A,Crocker A,Xiao D,Ahluwalia JS,DeLeire T,Shara N,Al-Refaie W

doi

10.1016/j.jamcollsurg.2018.08.693

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

507-520.e9

issue

5

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(18)31993-8

journal_volume

227

pub_type

杂志文章

相关文献

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS文献大全
  • Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands.

    abstract：:One hundred and seventy consecutive patients undergoing parathyroid gland exploration and bilateral thyroidectomy received, postoperatively, routine oral calcium supplementation, close monitoring of total serum calcium, and addition of vitamin D for specific criteria, all to accomplish a postoperative course free of s...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：

    authors： Moore FD Jr

    更新日期：1994-01-01 00:00:00

  • Production of interleukin-6 at operative wound sites in surgical patients.

    abstract：BACKGROUND:Interleukin-6 (IL-6) plays a central role in the acute phase of inflammation after surgical injury. The serum concentration of IL-6 increases during an operation. The mechanisms of this increase in the serum IL-6 level, however, has not yet been fully clarified. STUDY DESIGN:To determine the possibility of ...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：

    authors： Ueo H,Inoue H,Honda M,Uchida I,Nishimura M,Arinaga S,Nakashima H,Akiyoshi T

    更新日期：1994-09-01 00:00:00

  • Success of carotid endarterectomy in veterans: high medical risk does not equate with high surgical risk.

    abstract：BACKGROUND:The safety and efficacy of carotid endarterectomy (CEA) in stroke prevention has been well documented. But "high-risk" patients have traditionally been excluded from these studies and may be offered alternate therapies. We examined the safety of CEA in veterans, a medically high-risk group with multiple como...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2008.02.033

    authors： Fitzgerald TN,Popp C,Federman DG,Dardik A

    更新日期：2008-08-01 00:00:00

  • Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy.

    abstract：BACKGROUND:Most studies comparing surgical results of laparoscopic procedures for gastric cancer with open gastrectomies have been conducted based on limited experience. We aimed to compare laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) after a protracted learning experien...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2006.02.028

    authors： Lee SI,Choi YS,Park DJ,Kim HH,Yang HK,Kim MC

    更新日期：2006-06-01 00:00:00

  • Pancreas transplantation in C-peptide positive patients: does "type" of diabetes really matter?

    abstract：BACKGROUND:In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). STUDY DESIGN:We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL. RESULTS:From Nove...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2014.12.020

    authors： Stratta RJ,Rogers J,Farney AC,Orlando G,El-Hennawy H,Gautreaux MD,Reeves-Daniel A,Palanisamy A,Iskandar SS,Bodner JK

    更新日期：2015-04-01 00:00:00

  • Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection.

    abstract：BACKGROUND:Postoperative ileus (POI), an interruption of coordinated bowel motility after operation, is exacerbated by opioids used to manage pain. Alvimopan, a peripherally acting mu-opioid receptor antagonist, accelerated gastrointestinal (GI) recovery after bowel resection in randomized, double-blind, placebo-contro...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章,多中心研究,随机对照试验

    doi：10.1016/j.jamcollsurg.2007.01.041

    authors： Wolff BG,Weese JL,Ludwig KA,Delaney CP,Stamos MJ,Michelassi F,Du W,Techner L

    更新日期：2007-04-01 00:00:00

  • Predictors of comprehension during surgical informed consent.

    abstract：BACKGROUND:Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN:Patients sched...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章,多中心研究,随机对照试验

    doi：10.1016/j.jamcollsurg.2010.02.049

    authors： Fink AS,Prochazka AV,Henderson WG,Bartenfeld D,Nyirenda C,Webb A,Berger DH,Itani K,Whitehill T,Edwards J,Wilson M,Karsonovich C,Parmelee P

    更新日期：2010-06-01 00:00:00

  • Sterility of the surgical site marking between the ink and the epidermis.

    abstract：BACKGROUND:To prevent wrong-site surgery, multiple organizations have endorsed the practice of signing the operative site with an indelible marker. Potential contamination of the surgical field and the inability to prepare the area under the ink film raises concerns. The purpose of this study was to determine if the us...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2007.02.029

    authors： Cullan DB 2nd,Wongworawat MD

    更新日期：2007-08-01 00:00:00

  • A survey of hospital management practices for vulvar melanoma.

    abstract：BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/s1072-7515(99)00033-2

    authors： Creasman WT,Phillips JL,Menck HR

    更新日期：1999-06-01 00:00:00

  • Reduction in Venous Thromboembolism Events: Trauma Performance Improvement and Loop Closure Through Participation in a State-Wide Quality Collaborative.

    abstract：BACKGROUND:The Michigan Trauma Quality Improvement Program (MTQIP) is a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BCN). The MTQIP benchmark reports identified our trauma center as a high outlier for venous thromboembolism (VTE) episodes. This study out...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2015.05.006

    authors： Machado-Aranda DA,Jakubus JL,Wahl WL,Cherry-Bukowiec JR,To KB,Park PK,Raghavendran K,Napolitano LM,Hemmila MR

    更新日期：2015-09-01 00:00:00

  • Digital fecal occult blood testing in the ambulatory urology clinic.

    abstract：BACKGROUND:This study was designed to evaluate the use and yield of fecal occult blood testing (FOBT) in an ambulatory urology clinic. STUDY DESIGN:Patients seen in the ambulatory urology clinic were prospectively evaluated with FOBT. The test was performed only on patients when a rectal examination was indicated as p...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2007.06.295

    authors： Goetzl MA,Outman JE,Griebling TL,Holzbeierlein JM,Weigel JW,Thrasher JB

    更新日期：2008-01-01 00:00:00

  • Survival of the fittest: the hidden cost of undertriage of major trauma.

    abstract：BACKGROUND:Injured patients cared for in trauma centers have a lower risk of death than those cared for in nontrauma centers. However, many patients are transported to a non-trauma center after injury (undertriaged) and require transfer to trauma center care. Previous analyses of undertriage focused only on survivors t...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2010.08.014

    authors： Haas B,Gomez D,Zagorski B,Stukel TA,Rubenfeld GD,Nathens AB

    更新日期：2010-12-01 00:00:00

  • Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume.

    abstract：BACKGROUND:Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a more stringent patient selection, mortality after hepatic resection has steadily decreased, but its incidence still ranges from 10% to 20%. The factors linked to...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/s1072-7515(98)00301-9

    authors： Shirabe K,Shimada M,Gion T,Hasegawa H,Takenaka K,Utsunomiya T,Sugimachi K

    更新日期：1999-03-01 00:00:00

  • Is fever protective in surgical patients with bloodstream infection?

    abstract：BACKGROUND:Sepsis from bloodstream infection (BSI) is an important cause of morbidity and mortality among surgical patients. Our hypothesis was that fever and leukocytosis during BSI would be associated with gram-negative pathogens and worse outcomes among hospitalized surgical patients. STUDY DESIGN:A prospectively c...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2007.01.033

    authors： Swenson BR,Hedrick TL,Popovsky K,Pruett TL,Sawyer RG

    更新日期：2007-05-01 00:00:00

  • Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19).

    abstract：:The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a pandemic on March 11. This had led to the calling of a national emergency on March 13 in the US. Many hospitals, healthcare networks, and s...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2020.03.019

    authors： Ross SW,Lauer CW,Miles WS,Green JM,Christmas AB,May AK,Matthews BD

    更新日期：2020-06-01 00:00:00

  • Getting a head start: high-fidelity, simulation-based operating room team training of interprofessional students.

    abstract：BACKGROUND:Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immedi...

    journal_title：Journal of the American College of Surgeons

    pub_type： 临床试验,杂志文章

    doi：10.1016/j.jamcollsurg.2013.09.006

    authors： Paige JT,Garbee DD,Kozmenko V,Yu Q,Kozmenko L,Yang T,Bonanno L,Swartz W

    更新日期：2014-01-01 00:00:00

  • Telemedicine: a solution to the followup of rural trauma patients?

    abstract：BACKGROUND:Outpatient followup of rural trauma patients is problematic for physicians and patients. Our hypothesis was that telemedicine-based followup of trauma patients discharged to remote areas is feasible and is associated with high patient and physician satisfaction. STUDY DESIGN:We chose 11 counties in Kentucky...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/s1072-7515(01)00796-7

    authors： Boulanger B,Kearney P,Ochoa J,Tsuei B,Sands F

    更新日期：2001-04-01 00:00:00

  • Cost Analysis of Free Colonoscopies in an Uninsured Population at Increased Risk for Colorectal Cancer.

    abstract：BACKGROUND:Uninsured patients have poor access to screening colonoscopy and subsequently present with advanced stages of colorectal cancer (CRC) that beget worse outcomes and higher total costs. Providing pro bono colonoscopies to uninsured patients at high risk for CRC can detect early stage disease and be cost-effect...

    journal_title：Journal of the American College of Surgeons

    pub_type： 临床试验,杂志文章

    doi：10.1016/j.jamcollsurg.2016.04.035

    authors： Sutton ER,Walling S,Kimbrough C,Borkhetaria N,Jones W,Sutton B

    更新日期：2016-07-01 00:00:00

  • Atypical variants of classic achalasia are common and currently under-recognized: a study of prevalence and clinical features.

    abstract：BACKGROUND:Advances in esophageal manometry have facilitated identification of variants of achalasia, suggesting they are more common than previously thought. This study assesses the frequency and clinical characteristics of patients with motility abnormalities similar to, but not meeting criteria for, classic achalasi...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2011.02.008

    authors： Galey KM,Wilshire CL,Niebisch S,Jones CE,Raymond DP,Litle VR,Watson TJ,Peters JH

    更新日期：2011-07-01 00:00:00

  • Comparative analysis of sentinel lymph node operation in male and female breast cancer patients.

    abstract：BACKGROUND:Male breast cancer accounts for < 1% of breast cancers. Sentinel lymph node (SLN) operation is commonly used in the evaluation of female breast cancer patients. The purpose of this study was to determine whether SLN operation is as feasible and accurate in male patients compared with female patients. STUDY ...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2006.06.014

    authors： Boughey JC,Bedrosian I,Meric-Bernstam F,Ross MI,Kuerer HM,Akins JS,Giordano SH,Babiera GV,Ames FC,Hunt KK

    更新日期：2006-10-01 00:00:00

  • Outpatient Laparoscopic Appendectomy: Is It Time to End the Discussion?

    abstract：BACKGROUND:Laparoscopic appendectomy is typically associated with inpatient hospitalization averaging between 1 and 2 days. In July 2010, a prospective protocol for outpatient laparoscopic appendectomy was adopted at our institution. Patients were dismissed from the post-anesthesia recovery room or day surgery if they ...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2015.12.053

    authors： Frazee RC,Abernathy SW,Isbell CL,Isbell T,Regner JL,Smith RD

    更新日期：2016-04-01 00:00:00

  • Impact of cirrhosis on outcomes in trauma.

    abstract：BACKGROUND:Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality. STUDY DESIGN:The trauma registry at our Level I trauma center was queried for all ICD-9 cod...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2006.08.001

    authors： Dangleben DA,Jazaeri O,Wasser T,Cipolle M,Pasquale M

    更新日期：2006-12-01 00:00:00

  • Are surgical trials with negative results being interpreted correctly?

    abstract：BACKGROUND:Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN:We examined 54 reports of surgical trials chosen randomly from a database...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2012.09.015

    authors： Brody BA,Ashton CM,Liu D,Xiong Y,Yao X,Wray NP

    更新日期：2013-01-01 00:00:00

  • Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients.

    abstract：BACKGROUND:The anatomic difficulties that we have to deal with in open surgery for rectal cancer have not been overcome with the laparoscopic approach. In the search for a solution, a change of concept arose: approaching the rectum from below. The main objectives of this study were to show the potential advantages of t...

    journal_title：Journal of the American College of Surgeons

    pub_type： 临床试验,杂志文章

    doi：10.1016/j.jamcollsurg.2015.03.046

    authors： Lacy AM,Tasende MM,Delgado S,Fernandez-Hevia M,Jimenez M,De Lacy B,Castells A,Bravo R,Wexner SD,Heald RJ

    更新日期：2015-08-01 00:00:00

  • Surgical management of acute right lower-quadrant pain in pregnancy: a prospective cohort study.

    abstract：BACKGROUND:The etiology of right lower-quadrant pain in pregnant patients is a challenge in diagnosis. We discuss the surgical issues among pregnant patients with right lower-quadrant pain and demonstrate the method to diagnosis. STUDY DESIGN:This was a prospective cohort study with enrollment during 2 years. Pregnant...

    journal_title：Journal of the American College of Surgeons

    pub_type： 临床试验,杂志文章

    doi：10.1016/j.jamcollsurg.2010.06.004

    authors： Butala P,Greenstein AJ,Sur MD,Mehta N,Sadot E,Divino CM

    更新日期：2010-10-01 00:00:00

  • Motorcycle helmets associated with lower risk of cervical spine injury: debunking the myth.

    abstract：BACKGROUND:There has been a repeal of the universal helmet law in several states despite definitive evidence that helmets reduce mortality, traumatic brain injury, and hospital expenditures. Opponents of the universal helmet law have successfully claimed that helmets should not be required because of greater torque on ...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2010.09.032

    authors： Crompton JG,Bone C,Oyetunji T,Pollack KM,Bolorunduro O,Villegas C,Stevens K,Cornwell EE 3rd,Efron DT,Haut ER,Haider AH

    更新日期：2011-03-01 00:00:00

  • Is CT Angiography of the Head Useful in the Management of Traumatic Brain Injury?

    abstract：BACKGROUND:Computed tomography angiography (CTA) has been increasingly used in traumatic brain injury (TBI) patients to uncover vascular lesions that might have preceded the trauma and caused the bleed. This study aims to evaluate the usefulness of head CTA in the initial care of blunt TBI patients. STUDY DESIGN:We co...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2015.03.002

    authors： Naraghi L,Larentzakis A,Chang Y,Duhaime AC,Kaafarani H,Yeh DD,King DR,de Moya MA,Velmahos GC

    更新日期：2015-06-01 00:00:00

  • Organizational Culture Changes Result in Improvement in Patient-Centered Outcomes: Implementation of an Integrated Recovery Pathway for Surgical Patients.

    abstract：BACKGROUND:The goals of quality improvement are to partner with patients and loved ones to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste, yet few programs have successfully worked on of all these in concert. STUDY DESIGN:We evaluated implementation of a pathway designe...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2015.05.008

    authors： Wick EC,Galante DJ,Hobson DB,Benson AR,Lee KH,Berenholtz SM,Efron JE,Pronovost PJ,Wu CL

    更新日期：2015-09-01 00:00:00

  • Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases.

    abstract：BACKGROUND:Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lym...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2011.09.024

    authors： Solon JG,Power C,Al-Azawi D,Duke D,Hill AD

    更新日期：2012-01-01 00:00:00

  • Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring.

    abstract：BACKGROUND:After excision of an abnormal gland, the dynamics of intraoperative parathyroid hormone (PTH) levels signal whether or not more hypersecreting tissue is present. This quantitative assurance of operative success has led to targeted exploration of the hyperfunctioning gland(s). Some have questioned the need fo...

    journal_title：Journal of the American College of Surgeons

    pub_type： 杂志文章

    doi：10.1016/j.jamcollsurg.2006.02.003

    authors： Carneiro-Pla DM,Solorzano CC,Irvin GL 3rd

    更新日期：2006-05-01 00:00:00