The Center for Surgical Health (CSH): A Surgical Equity Intervention in Plastic Surgery

Abstract

Background: The Center for Surgical Health (CSH) works to improve surgical access for under-resourced communities in Philadelphia via patient navigation services. This study defined the social profiles, clinical needs, and satisfaction of patients engaging with the Plastic and Hand Surgery (PHS) division of CSH.

Methods: Patients referred from June 2019 to October 2024 were included. Eligible patients received NE2AR support: navigation, education, empowerment, access to payers and providers, and screening for legal and social referrals. Patient demographic, insurance, and clinical data were collected and summarized using descriptive statistics. After completion of CSH services, all patients were surveyed to assess satisfaction with navigators and seven domains of the surgical care accessed through CSH using items from the National Cancer Institute Patient Satisfaction Navigator Interpersonal Survey and the RAND Patient Satisfaction Questionnaire-18, two validated patient satisfaction surveys. PHS satisfaction scores were compared to non-PHS patients using two-sided t tests.

Results: Of 1146 referrals to CSH, 128 (11.2%) were for PHS. The procedures sought included post-traumatic upper extremity (27.3%) and facial reconstruction (7.0%), gender-affirming surgery (25.0%), and lesion excision (22.7%). Most patients identified as Hispanic/Latinx (35.9%) or Black (36.2%), and 33.6% were primarily Spanish-speaking. A majority of referred patients (74.6%) did not have insurance at the time of referral. Sixty-three patients (49.2%) were eligible for CSH services. Navigators predominantly applied for state-based insurance, including Emergency Medical Assistance (70.1%) and Medicaid (17.7%). PHS patients were highly satisfied with navigators (mean, 38.3; SD, 6.3; max, 45) but were dissatisfied with the Financial Aspects (mean, 2.5; SD, 1.1; max, 5) and Accessibility/Convenience (mean, 3.4; SD, 0.8; max, 5) care domains. PHS patients were less satisfied with Financial Aspects relative to non-PHS patients (mean, 3.27; SD, 0.1; P = 0.02).

Conclusions: CSH navigators provided NE2AR surgical navigation for primarily uninsured and historically marginalized PHS patients and increased access to a variety of surgeries that would be otherwise difficult or impossible to obtain. Although PHS patients were generally satisfied, the results highlight persistent barriers for underresourced groups.