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Challenges in Surgical Quality at Safety-Net Hospitals

Ryan Macht, MD1; David McAneny, MD1; Gerard Doherty, MD1
[+] Author Affiliations
1Department of Surgery, Boston Medical Center, Boston, Massachusetts
JAMA Surg. 2016;151(9):795-796. doi:10.1001/jamasurg.2016.0986.
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This Viewpoint explores the changes that can be made to more equitably evaluate and improve surgical quality at safety-net hospitals, which provide care for a large proportion of Medicaid, uninsured, underinsured, or otherwise vulnerable patients but have been shown to have worse surgical quality outcomes.

Safety-net hospitals (SNHs) are critical to the US health care system, providing care for a large proportion of Medicaid, uninsured, underinsured, or otherwise vulnerable patients. Recent studies have shown that some surgical quality outcomes are worse at SNHs.1 This has been largely attributed to the SNH patient population, typically with worse overall health and more advanced disease presentation. However, Hoehn et al2 recently noted in JAMA Surgery that inferior surgical outcomes at high safety-net burden hospitals persist even after adjusting for patient and hospital characteristics. The authors concluded that intrinsic qualities of SNHs might be responsible for the observed deficiencies, although the nature of these qualities and approaches to address them remain obscure. We believe that a complex series of factors at the individual, organizational, and policy levels are responsible for both real and perceived disparities in outcomes at SNHs, but specific changes may be applied to more equitably evaluate and improve surgical quality at these institutions.

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