{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:43:31Z","timestamp":1790444611841,"version":"4.1.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Racial disparities in treatment benchmarks have been documented among older patients with hip fractures. However, these studies were limited to patient-level evaluations.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess whether disparities in meeting fracture care time-to-surgery benchmarks exist at the patient level or at the hospital or institutional level using high-quality multicenter prospectively collected data; the study hypothesis was that disparities at the hospital-level reflecting structural health systems issues would be detected.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study was a secondary analysis of prospectively collected data in the PREP-IT (Program of Randomized trials to Evaluate Preoperative antiseptic skin solutions in orthopaedic Trauma) program from 23 sites throughout North America. The PREP-IT trials enrolled patients from 2018 to 2021, and patients were followed for 1-year. All patients with hip and femur fractures enrolled in the PREP-IT program were included in analysis. Data were analyzed April to September 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Patient-level and hospital-level race, ethnicity, and insurance status.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Primary outcome measure was time to surgery based on 24-hour time-to-surgery benchmarks. Multilevel multivariate regression models were used to evaluate the association of race, ethnicity, and insurance status with time to surgery. The reported odds ratios (ORs) were per 10% change in insurance coverage or racial composition at the hospital level.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 2565 patients with a mean (SD) age of 64.5 (20.4) years (1129 [44.0%] men; mean [SD] body mass index, 27.3 [14.9]; 83 [3.2%] Asian, 343 [13.4%] Black, 2112 [82.3%] White, 28 [1.1%] other) were included in analysis. Of these patients, 834 (32.5%) were employed and 2367 (92.2%) had insurance; 1015 (39.6%) had sustained a femur fracture, with a mean (SD) injury severity score of 10.4 (5.8). Five hundred ninety-six patients (23.2%) did not meet the 24-hour time-to-operating-room benchmark. After controlling for patient-level characteristics, there was an independent association between missing the 24-hour benchmark and hospital population insurance coverage (OR, 0.94; 95% CI, 0.89-0.98; P<\/jats:italic>\u2009=\u2009.005) and the interaction term between hospital population insurance coverage and racial composition (OR, 1.03; 95% CI, 1.01-1.05; P<\/jats:italic>\u2009=\u2009.03). There was no association between patient race and delay beyond 24-hour benchmarks (OR, 0.96; 95% CI, 0.72-1.29; P<\/jats:italic>\u2009=\u2009.79).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, patients who sought care from an institution with a greater proportion of patients with racial or ethnic minority status or who were uninsured were more likely to experience delays greater than the 24-hour benchmarks regardless of the individual patient race; institutions that treat a less diverse patient population appeared to be more resilient to the mix of insurance status in their patient population and were more likely to meet time-to-surgery benchmarks, regardless of patient insurance status or population-based insurance mix. While it is unsurprising that increased delays were associated with underfunded institutions, the association between institutional-level racial disparity and surgical delays implies structural health systems bias.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.44357","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T16:32:55Z","timestamp":1669825975000},"page":"e2244357","source":"Crossref","is-referenced-by-count":12,"title":["Association of Patient-Level and Hospital-Level Factors With Timely Fracture Care by Race"],"prefix":"10.1001","volume":"5","author":[{"given":"Ida Leah","family":"Gitajn","sequence":"first","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Werth","sequence":"additional","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Lebanon, New 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