Background: CSH works to improve the surgical health of under-resourced communities. This study defined the social profiles, clinical needs, and satisfaction of patients engaging with CSH’s Plastic Surgery (PS) Division.
Methods: Patients referred from June 2019 to March 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 7 domains of surgical care accessed through CSH. PS satisfaction scores were compared to non-PS patients using two-sided t-tests.
Results: Of 968 CSH referrals, 108 (11.2%) were for PS. The procedures sought included gender-affirming surgery (27.8%), lesion excision (23.2%), post-traumatic upper extremity (22.2%) and facial reconstruction (6.5%), and breast reduction (3.7%) among others (16.7%). Most patients identified as Hispanic/Latinx (35.2%) or Black (36.1%). Of 55 patients eligible for CSH services, 41 (74.6%) were uninsured. Navigators mainly applied for state-based insurance, including Emergency Medical Assistance (68.2%) and Medicaid (20.5%). PS patients were highly satisfied with navigators (M 38.3, SD 6.3, max 45) but were dissatisfied with the Financial Aspects (M 2.5, SD 1.1, max 5; FA) and Accessibility/Convenience (M 3.4, SD 0.8, max 5) care domains. PS patients were less satisfied with FA relative to non-PS patients (M 3.27, SD 0.1; p=0.02).
Conclusion: Under the mentorship of PS “lead residents” and faculty, CSH navigators (largely PS-interested medical and undergraduate students) provided NE2AR© surgical navigation for primarily uninsured and historically marginalized PS patients and increased access to a variety of surgeries that would be otherwise difficult or impossible to obtain. Though PS patients were generally satisfied, the results highlight persistent barriers for under-resourced groups.
