Operation Access: a proven model for providing volunteer surgical services to the uninsured in the United States.
BACKGROUND
Numerous studies have shown that patients without insurance lack coordinated health care and access to surgical procedures. Operation Access (OA) has coordinated uncompensated, low-risk outpatient surgical and specialty services to the uninsured in a volunteer setting for 15 years. Our objective was to evaluate the quality of outpatient surgical care provided by OA volunteers.


METHODS
Retrospective cohort study using data from OA's secure database to evaluate the quality of care provided to all patients eligible for OA services from 1994 through 2008. Primary outcomes included quality of care as measured by the Institute of Medicine's six quality aims, ie, safety, efficiency, effectiveness, timeliness, patient-centered care, and equity.


RESULTS
Six-thousand five-hundred and forty-two patients were referred to OA during the past 15 years; 83.4% met eligibility criteria. Of these, 3,518 unduplicated patients received 3,098 surgical, endoscopic, and minor procedures. Only 12 of 1,880 surgical patients experienced a complication requiring hospitalization. Patient care was efficient, with a 95.3% overall compliance rate; approximately $7.56 of services were provided for every dollar of philanthropic support. OA's strong emphasis on case management, focus on continuity of care, and patient-selection criteria contributed to the organization's provision of safe, efficient, effective, timely, and patient-centered care. A higher percentage of Latinos and a lower percentage of African Americans relative to the geographic demographics received OA services.


CONCLUSIONS
A volunteer program providing low-risk outpatient operations using the OA model delivers safe, efficient, effective, timely, and patient-centered care.
Matula
Sierra R
SR
Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, Los Angeles, CA 94110, USA.
Beers
Jason
J
Errante
Jennifer
J
Grey
Douglas
D
Hofmann
Paul B
PB
Schecter
William P
WP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000533:Altruism; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D013502:General Surgery; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States; D014838:Volunteers; D000078329:Workforce; D055815:Young Adult