Angela L Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z Kiani, Neeta Vachharajani, Franklin C Olumba, Sally Campbell, Adeel S Khan, William C Chapman, Majella B Doyle
{"title":"初级保健医生的地域差异：当地对成人肝移植受者长期疗效的影响。","authors":"Angela L Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z Kiani, Neeta Vachharajani, Franklin C Olumba, Sally Campbell, Adeel S Khan, William C Chapman, Majella B Doyle","doi":"10.1016/j.amjsurg.2024.116023","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care.</p><p><strong>Methods: </strong>Clinical data on adults undergoing liver-only transplant 2010-2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival.</p><p><strong>Results: </strong>64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%-8% lower mortality risk (HR<sub>3rd</sub> = 0.94, HR<sub>4th</sub> = 0.92, HR<sub>5th</sub> = 0.94, p for trend = 0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p = 0.002).</p><p><strong>Conclusions: </strong>Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116023"},"PeriodicalIF":2.7000,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Geographic disparities in primary care physicians: Local impact on long-term outcomes in adult liver transplant recipients.\",\"authors\":\"Angela L Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z Kiani, Neeta Vachharajani, Franklin C Olumba, Sally Campbell, Adeel S Khan, William C Chapman, Majella B Doyle\",\"doi\":\"10.1016/j.amjsurg.2024.116023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care.</p><p><strong>Methods: </strong>Clinical data on adults undergoing liver-only transplant 2010-2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival.</p><p><strong>Results: </strong>64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%-8% lower mortality risk (HR<sub>3rd</sub> = 0.94, HR<sub>4th</sub> = 0.92, HR<sub>5th</sub> = 0.94, p for trend = 0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p = 0.002).</p><p><strong>Conclusions: </strong>Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.</p>\",\"PeriodicalId\":7771,\"journal\":{\"name\":\"American journal of surgery\",\"volume\":\" \",\"pages\":\"116023\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-10-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amjsurg.2024.116023\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjsurg.2024.116023","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Geographic disparities in primary care physicians: Local impact on long-term outcomes in adult liver transplant recipients.
Background: Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care.
Methods: Clinical data on adults undergoing liver-only transplant 2010-2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival.
Results: 64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%-8% lower mortality risk (HR3rd = 0.94, HR4th = 0.92, HR5th = 0.94, p for trend = 0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p = 0.002).
Conclusions: Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.
期刊介绍：
The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.
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