Perspective: identifying and addressing disparities in surgical access: a health systems call to action

As surgical quality improvement programs proliferate, we must return to 1 of the central tenets of the National Institute of Health—American College of Surgeons (ACS) Symposium on Surgical Disparities Research: “No quality without access.” Disparities across the continuum of surgical care also extend to access to surgical care. A 2019 systematic literature review of studies conducted in the United States identified 223 surgical access study outcomes with demonstrated disparities across a surgical access framework: Provider Access, Surgical Indication Detection, Progression to Surgery, or Optimal Care Capacity.1 To compare these potential quality measures with existing surgical performance measures, this framework was applied to an environmental scan of measure repositories and survey of quality experts, returning only 16 validated measures of surgical access. This critical gap is a clear charge for health systems to mitigate population-level disparities in surgical care by incorporating surgical access measures

Disparities in surgical access: a systematic literature review, conceptual model, and evidence map

[Extract] Healthcare disparities in quality represent one of the greatest challenges in achieving uniformly high-quality care. Research reporting disparities in surgical outcomes are abundant. The cornerstone of delivering high-quality healthcare is ensuring optimal access for all patients. A relative lack of access to surgical services might be a contributing factor to disparities in surgical outcomes. Access is "the timely use of personal health services to achieve the best possible outcomes." Use of services, the process of entering and staying in the system, and the actual quality of care received are all involved. Disparities in access arise when the system disproportionately underperforms for a specific group of patients relative to the historically advantaged population.8, 9 Surgery, because of its time sensitive, often high-acuity nature, is greatly dependent on access

Disparity-Sensitive Measures in Surgical Care: A Delphi Panel Consensus

Background: In the US, disparities in surgical care impede the delivery of uniformly high-quality care to all patients. There is a lack of disparity-sensitive measures related to surgical care. The American College of Surgeons Metrics for Equitable Access and Care in Surgery group, through research and expert consensus, aimed to identify disparity-sensitive measures in surgical care. Study Design: An environmental scan, systematic literature review, and subspecialty society surveys were conducted to identify potential disparity-sensitive surgical measures. A modified Delphi process was conducted where panelists rated measures on both importance and validity. In addition, a novel literature-based disparity-sensitive scoring process was used. Results: We identified 841 potential disparity-sensitive surgical measures. From these, our Delphi and literature-based approaches yielded a consensus list of 125 candidate disparity-sensitive measures. These measures were rated as both valid and important and were supported by the existing literature. Conclusion: There are profound disparities in surgical care within the US healthcare system. A multidisciplinary Delphi panel identified 125 potential disparity-sensitive surgical measures that could be used to track health disparities, evaluate the impact of focused interventions, and reduce healthcare inequity

Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics

BACKGROUND: Disparity in surgical care impedes the delivery of uniformly high-quality care. Metrics that quantify disparity in care can help identify areas for needed intervention. A literature-based Disparity-Sensitive Score (DSS) system for surgical care was adapted by the Metrics for Equitable Access and Care in Surgery (MEASUR) group. The alignment between the MEASUR DSS and Delphi ratings of an expert advisory panel (EAP) regarding the disparity sensitivity of surgical quality metrics was assessed. STUDY DESIGN: Using DSS criteria MEASUR co-investigators scored 534 surgical metrics which were subsequently rated by the EAP. All scores were converted to a 9-point scale. Agreement between the new measurement technique (ie DSS) and an established subjective technique (ie importance and validity ratings) were assessed using the Bland-Altman method, adjusting for the linear relationship between the paired difference and the paired average. The limit of agreement (LOA) was set at 1.96 SD (95%). RESULTS: The percentage of DSS scores inside the LOA was 96.8% (LOA, 0.02 points) for the importance rating and 94.6% (LOA, 1.5 points) for the validity rating. In comparison, 94.4% of the 2 subjective EAP ratings were inside the LOA (0.7 points). CONCLUSIONS: Applying the MEASUR DSS criteria using available literature allowed for identification of disparity-sensitive surgical metrics. The results suggest that this literature-based method of selecting quality metrics may be comparable to more complex consensus-based Delphi methods. In fields with robust literature, literature-based composite scores may be used to select quality metrics rather than assembling consensus panels. (J Am Coll Surg 2023;237:856–861