Improving Surgery Outcomes and Access
HAS is working with researchers from the Center for Surgery and Public Health at Brigham and Women’s Hospital and Harvard Medical School to increase access to surgical care, regardless of patient income.
The poorest members of the HAS service area are living in mountainous areas and do not access surgical care at the same rate as the higher-income patients living in the valley. While the HAS social service program provides free care for those most in need once they get to HAS, this benefit is under-utilized by the mountain patients. At the start of the program, patients from the valley areas closest to the hospital received approximately 13.8 operations per 10,000 people in the population compared to just 3.7 operations per 10,000 mountain patients. To address this disparity, HAS has trained patient navigators to guide pre-screened patients from the mountains through the hospital system. This program started in March 2014 to much success, demonstrating a 3-fold increase in elective operations for the mountain population by 2015, as compared with the 2013 baseline. As of April 2016, 200 mountain patients have received an operation at HAS through this program.
With Dr. Matousek, HAS also conducts an innovative program for the early detection of surgical site infections (SSI’s) among these mountain patients once they have been discharged post-operatively. HAS has trained and equipped community health workers in the HAS service area to use durable smart phones to perform home visits for surgical patients, complete a survey on symptoms of SSI and take a quality photograph of the incision site. As many of these patients have higher difficulty seeking outpatient care, we strive to make sure that as we reach out to more mountain patients, we maintain very low rates of infection. The program started as a pilot on April 1, 2014, and now has reached more than 190 patients with home visits to date. This program will form the foundation for future outpatient outcomes studies in Haiti and perhaps inform cost-reduction efforts in the United States through a successful example of task shifting.
These programs were informed by the results of a 2013-2014 study conducted by the same researchers, which found that after adjusting for the types of cases performed at HAS, the infection rate is impressively low at just 2.9% when measured at hospital discharge. This study enrolled more than 1100 patients in 2013-2014 and has helped inform plans for future research into how to practically reduce morbidity from surgical infections in low-resource settings.