Disparities in access to healthcare services in a regional neonatal transport network

IF 2.5 2区 工程技术 Q2 ENGINEERING, INDUSTRIAL International Journal of Industrial Ergonomics Pub Date : 2023-12-05 DOI:10.1016/j.ergon.2023.103526
Taylor Riley , Rachel Umoren , Annabelle Kotler , John Feltner , Zeenia Billimoria , Jasmine James , Adithi Mahankali , Cailin White , Ivana Brajkovic , Megan M. Gray
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Abstract

Introduction

The disproportionate distribution of healthcare resources in the U.S. leads to an annual estimated 68,000 critically-ill newborns transported to regional centers for intensive care. As described in the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, patients with limited access to healthcare experience multiple healthcare settings in their journey to specialty care. Little is known about community resources for transported neonatal patients in the Pacific Northwest region.

Methods

Transport data from January 2014–December 2019 identified referral zip codes for transfers to a regional neonatal intensive care unit (NICU). Using the SEIPS 3.0 framework to explore the journey of families experiencing neonatal complications, we linked referral zip codes to data on healthcare and resource access including: Health Transportation Shortage Index (HTSI); US Census Small Area Income and Poverty Estimates; public transportation availability; Health Professional Shortage Area (HPSA) and number of Federally Qualified Health Centers.

Results

1834 neonatal transports from 75 zip codes were analyzed. Forty percent of patients were transferred from a HPSA, one-quarter from areas with limited public transit availability (28%) and household internet access (24%). Almost all infants transferred from a high HTSI area (96%) were transported by air.

Conclusion

Many patients were referred from communities with high poverty and limited services. Improving patient outcomes requires population and policy level recommendations and care coordination between healthcare organizations and community services. Considering the patient family perspective within the SEIPS 3.0 framework will ensure patient centered care and an inclusive experience for families transitioning through healthcare settings.

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在区域新生儿运输网络中获得保健服务的差距
在美国,医疗资源的不成比例分布导致每年估计有68,000名危重新生儿被运送到地区中心进行重症监护。正如患者安全系统工程计划(SEIPS) 3.0框架中所描述的那样,获得医疗保健的机会有限的患者在获得专业护理的过程中会经历多种医疗保健设置。对于太平洋西北地区运送新生儿患者的社区资源了解甚少。方法2014年1月至2019年12月的stransport数据确定了转至地区新生儿重症监护病房(NICU)的转诊邮政编码。使用SEIPS 3.0框架来探索经历新生儿并发症的家庭之旅,我们将转诊邮政编码与医疗保健和资源获取数据联系起来,包括:卫生运输短缺指数(HTSI);美国人口普查小地区收入和贫困估算;公共交通的可用性;卫生专业人员短缺地区(HPSA)和联邦合格卫生中心的数量。结果对来自75个邮政编码的1834例新生儿转运进行了分析。40%的患者来自HPSA,四分之一的患者来自公共交通有限的地区(28%)和家庭互联网接入有限的地区(24%)。几乎所有从高HTSI地区转移的婴儿(96%)都是通过空运转移的。结论许多患者来自高贫困社区和服务有限的社区。改善患者预后需要人口和政策层面的建议以及医疗保健组织和社区服务之间的护理协调。在SEIPS 3.0框架内考虑患者家庭的观点,将确保以患者为中心的护理,并为家庭提供通过医疗保健环境过渡的包容性体验。
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来源期刊
International Journal of Industrial Ergonomics
International Journal of Industrial Ergonomics 工程技术-工程:工业
CiteScore
6.40
自引率
12.90%
发文量
110
审稿时长
56 days
期刊介绍: The journal publishes original contributions that add to our understanding of the role of humans in today systems and the interactions thereof with various system components. The journal typically covers the following areas: industrial and occupational ergonomics, design of systems, tools and equipment, human performance measurement and modeling, human productivity, humans in technologically complex systems, and safety. The focus of the articles includes basic theoretical advances, applications, case studies, new methodologies and procedures; and empirical studies.
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