Access evidence · source checklist
Calling an area underserved for surgery is a combined evidence claim. No single workforce map, facility directory or shortage designation establishes the full pathway from need to completed care.
Define “access” before collecting data
Access can refer to geographic reach, timely scheduling, affordability, eligibility, referral completion, language access, physical accessibility or the availability of a particular service. State the population, procedure or service category, geography and time period before selecting a metric.
The HRSA Data Warehouse offers downloads, custom exploration, mapping and program-specific resources. These tools help assemble evidence, but the newsroom must still verify each dataset’s definition, vintage and appropriate level of inference.
The five-source minimum
- Population need: a defined population measure, not an assumed procedure count.
- Workforce: current specialty and geography fields with category limitations stated.
- Facilities and services: evidence that a named setting actually provides the relevant service.
- Travel and referral pathway: a reproducible route or referral measure, including destination and time period.
- Realized access: scheduling, completion, transfer or other evidence showing what happened to eligible patients.
Depending on the question, payer rules, language access, disability access, anesthesia coverage, emergency availability and local capacity constraints may require additional sources.
A rural classification, social-vulnerability score or federal shortage designation can frame a research question. It does not automatically certify a shortage of surgical care.
Quality checks before publication
- Do all sources refer to compatible years and geographies?
- Are clinician categories and facility types defined consistently?
- Does the denominator represent residents, patients, visits, procedures or facilities?
- Are missing and suppressed values distinguished from zero?
- Is the result descriptive, associative or causal?
- Can another analyst reproduce the extraction and transformation?
Use bounded language
When the evidence is incomplete, describe the verified gap precisely: “The available county file does not establish whether this procedure is offered locally,” or “The source identifies a workforce measure but not appointment availability.” Avoid ranking communities or institutions without a validated, predeclared method.
For examples of how each evidence layer should be interpreted, consult the Surgical Workforce and Care Access hub.