Introduction: Healthcare disparities have been well-recognized to exist in Appalachian populations for over 50 years with substantial evidence demonstrating that Appalachians have overall poorer health and worse outcomes, even when receiving healthcare insurance. How these disparities relate to the management of various spinal disorders is unclear. Of particular interest are referral patterns, workup prior to referral, timeliness of appointments once referrals are made, difficulty of access based on time/distance to appointment, and the role of socioeconomic status with regards to management of spinal disorders.
Methods: We sought to address these questions retrospectively utilizing the West Virginia University Spine Center database, which serves as a triage point for spine surgeons at West Virginia University prior to initial clinical encounter. With over 30,000 initial encounters documented in the database, this serves as an ideal tool for investigating demographic and disparity-type questions within various subpopulations of Appalachia, particularly within West Virginia.
Results: An initial analysis has demonstrated clear referral pattern differences across counties in WV with regards to referring provider (MD/DO versus mid-level providers versus others). Demographic differences with the population presenting to the spine center are also evident with regards to smoking rates, age, gender, and body-mass index.
Conclusions: By exploring these questions related to healthcare disparities and how these affect management of spinal disorders in a subset of the Appalachian population, targeted systemic interventions can be applied both within our population and perhaps more broadly applied to similar care environments.
Patient Care: This work represents the first step to identifying how healthcare disparities alter the management of spinal disorders in a disadvantaged Appalachian population. Using the outcomes of this work, targeted interventions can be applied in these communities to improve healthcare delivery. Results of these studies could then be applied to other environments with similar disparities.
Learning Objectives: 1.) Identify and understand healthcare disparities in Appalachia
2.) Explore how healthcare disparities contribute to management of spinal disorders and outcomes
3.) Identify mechanisms for improving healthcare delivery to those affected with healthcare disparities