1
|
Wang C, Zheng Y, Luo Z, Xie J, Chen X, Zhao L, Cao W, Xu Y, Wang F, Dong X, Tan F, Li N, He J. Socioeconomic characteristics, cancer mortality, and universal health coverage: A global analysis. MED 2024; 5:926-942.e3. [PMID: 38761802 DOI: 10.1016/j.medj.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/23/2024] [Accepted: 04/05/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association. METHODS We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC. FINDINGS The high (EAPC = -0.9% [95% CI, -1.0%, -0.9%]) and high-middle (-0.9% [-1.0%, -0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR] = 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference). CONCLUSIONS Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes. FUNDING This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science.
Collapse
Affiliation(s)
- Chenran Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zilin Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Xie
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolu Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesi Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
2
|
Ochoa-Dominguez CY, Pickering TA, Navarro S, Rodriguez C, Farias AJ. Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2024; 11:2224-2235. [PMID: 37369914 PMCID: PMC11236924 DOI: 10.1007/s40615-023-01690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality. METHODS We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group. RESULTS Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003). CONCLUSION Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.
Collapse
Affiliation(s)
- Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Claudia Rodriguez
- Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
- Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
3
|
Nogueira LM, May FP, Yabroff KR, Siegel RL. Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer in the United States. J Clin Oncol 2024; 42:1368-1377. [PMID: 37939323 DOI: 10.1200/jco.23.00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Young individuals racialized as Black are more likely to die after a colorectal cancer (CRC) diagnosis than individuals racialized as White in the United States. This study examined racial disparities in receipt of timely and guideline-concordant care among individuals racialized as Black and White with early-onset CRC. METHODS Individuals age 18-49 years racialized as non-Hispanic Black and White (self-identified) and newly diagnosed with CRC during 2004-2019 were selected from the National Cancer Database. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. Odds ratios (ORs) were adjusted for age and sex. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance, and facility type to the racial disparity in receipt of guideline-concordant care. The product-limit method was used to evaluate differences in time to treatment between patients racialized as Black and White. RESULTS Of the 84,882 patients with colon cancer and 62,573 patients with rectal cancer, 20.8% and 14.5% were racialized as Black, respectively. Individuals racialized as Black were more likely to not receive guideline-concordant care for colon (adjusted OR [aOR], 1.18 [95% CI, 1.14 to 1.22]) and rectal (aOR, 1.27 [95% CI, 1.21 to 1.33]) cancers. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively. Individuals racialized as Black had increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR], 1.28 [95% CI, 1.24 to 1.32]) and neoadjuvant chemoradiation for rectal cancer (HR, 1.42 [95% CI, 1.37 to 1.47]) compared with individuals racialized as White. CONCLUSION Patients with early-onset CRC racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.
Collapse
Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Folasade P May
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity, UCLA, Los Angeles, CA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| |
Collapse
|
4
|
Collins ML, Mack SJ, Whitehorn GL, Till BM, Grenda TR, Evans NR, Gordon SW, Okusanya OT. Access to Guideline Concordant Care for Node-Positive Non-Small Cell Lung Cancer in the United States. Ann Thorac Surg 2024; 117:568-575. [PMID: 37995842 DOI: 10.1016/j.athoracsur.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND This study sought to determine whether seeking care at multiple Commission on Cancer (CoC) hospitals is associated with different rates of receiving guideline-concordant care (GCC) among patients with non-small cell lung cancer (NSCLC). METHODS The National Cancer Database was queried for the years 2004 to 2018 for patients with margin-negative pT1 to pT3 N1 to N2 M0 noncarcinoid NSCLC without neoadjuvant therapy. GCC was defined as chemotherapy for pN1 disease and as chemotherapy with or without radiation for pN2 disease. Patients who received care at >1 facility were examined separately. Factors previously associated with barriers to care were compared between groups. Kaplan-Meier analysis with log-rank tests analyzed 5-year overall survival (OS). Propensity score matching was performed to compare the effect sizes of race, insurance status, and income. RESULTS In total 44,531 patients met inclusion criteria, 11,980 (26.9%) of whom sought care at >1 CoC institution. Among patients with pN1 disease, 5565 (76.7%) received GCC if they visited >1 facility vs 13,995 (68.5%) patients who sought care at 1 facility (P < .001). For patients with pN2 disease, 3991 (84.4%) received GCC if they visited >1 facility vs9369 (77.4%) patients receiving care at 1 facility (P < .001). Visiting >1 facility was associated with higher OS at 5 years (4784 [54.35%] vs 10,215 [45.62%]; P < .001). CONCLUSIONS Visiting >1 CoC institution is associated with higher rates of GCC for individuals with pN1 to pN2 lung cancer. Patients who received care at >1 facility had higher OS at 5 years. Further study is warranted to identify factors associated with the ability of patients to seek care at multiple facilities.
Collapse
Affiliation(s)
- Micaela L Collins
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Shale J Mack
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory L Whitehorn
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian M Till
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tyler R Grenda
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nathaniel R Evans
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sarah W Gordon
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Olugbenga T Okusanya
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| |
Collapse
|
5
|
Gao TP, Oresanya L, Green RL, Hamilton A, Kuo LE. Consolidation trends in vascular surgery. J Vasc Surg 2024; 79:412-417. [PMID: 37952782 DOI: 10.1016/j.jvs.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Practice consolidation by vertical and horizontal integration is a growing trend in surgery. Practice consolidation has not been previously examined in vascular surgery. METHODS The Medicare Provider Enrollment, Chain, and Ownership System data were used to identify vascular providers and vascular surgery practices in the United States in 2015 and 2020. Practices were categorized as solo (1 surgeon), small (2), medium (3-5), and large (≥6). The number of providers and the number of practices in each size group were determined. The Hirfendahl-Hirshman index (HHI), a measure of market consolidation, was calculated. Provider count, practice size, and HHI were additionally analyzed by urban and rural regions. All values were calculated for each time point and compared. RESULTS Vascular providers increased in number from 2929 to 3154 (7.7%) from 2015 to 2020. The number of practices decreased from 1351 to 1090 (19.3%). The number of large practices increased by 49.4%; the number of small or solo practices decreased by 42.1%. The mean HHI increased from 0.486 in 2015 to 0.498 in 2020. Both urban and rural regions had a decrease in solo practices (43.3% and 2.3%, respectively) and an increase in HHI (from 0.499 to 0.509 and 0.793 to 0.818, respectively). All changes were statistically significant. CONCLUSIONS From 2015 to 2020, there is a trend toward vascular providers working in larger practice groups and a corresponding increase in measures of market consolidation.
Collapse
Affiliation(s)
- Terry P Gao
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA.
| | - Lawrence Oresanya
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Rebecca L Green
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Audrey Hamilton
- Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| |
Collapse
|
6
|
Patel J, Attaluri V, Basam M, Ryoo J, Wu D, Mukherjee A, Chung J, Cooper RM, Haque R. Investigating Mortality Disparities Among Insured Patients With Colon Cancer Treated in an Integrated Health care System and Other Private Settings. Am Surg 2023; 89:5940-5948. [PMID: 37265450 DOI: 10.1177/00031348221146950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) affects health care delivery and is associated with worse outcomes. Integrated healthcare systems (IHS) may help reduce barriers to health care and affect outcomes. Our aim was to compare outcomes of colon cancer cases diagnosed at the largest IHS in California, Kaiser Permanente Southern California (KPSC), to other insured patients (OI) to determine how SES influences mortality. METHODS This retrospective cohort study included insured adults in southern California diagnosed with colon cancer between 2009 and 2014, using data from the California Cancer Registry, and followed through 2017. Main outcome was all-cause mortality. Person-year mortality rates were calculated for two groups, KPSC and OI. Multivariable hazard ratios were calculated for association between SES quintiles and mortality. RESULTS Total of 15 923 patients were diagnosed with colon cancer, 4195 patients (26.3%) within KPSC and 11 728 patients (73.7%) in OI. The overall mortality rate per 1000 person-years (PY) was lower in KPSC [103.8/1000 PY (95% CI:98.5-109.3)] compared to OI [139.3/1000 PY (95% CI:135.2-143.4)]. Compared to the highest SES group, the lowest SES group did not experience higher mortality risk in the KPSC population, after adjusting for race/ethnicity and other factors (HR, 95% CI = 1.13, .93-1.38). However, in OI patients, lowest and lower-middle SES groups had higher mortality risk compared to the highest SES group (HR, 95% CI = 1.26, 1.13-1.40 and 1.28, 1.16-1.41, respectively). DISCUSSION Lower SES was associated with higher mortality risk within the OI group; however, within KPSC no such association was observed. Care coordination in IHS settings mitigate SES-related mortality differences.
Collapse
Affiliation(s)
- Jay Patel
- Department of Surgery, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vikram Attaluri
- Department of Surgery, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Motahar Basam
- Department of Surgery, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Joan Ryoo
- Department of Radiation Oncology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - David Wu
- Department of Hematology Oncology, Kaiser Permanente Southern California, Fontana Medical Center, Fontana, CA, USA
| | - Amrita Mukherjee
- Kaiser Permanente Southern California, Research & Evaluation, Pasadena, CA, USA
| | - Joanie Chung
- Kaiser Permanente Southern California, Research & Evaluation, Pasadena, CA, USA
| | - Robert M Cooper
- Department of Pediatric Oncology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Reina Haque
- Kaiser Permanente Southern California, Research & Evaluation, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| |
Collapse
|
7
|
Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
Collapse
Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
8
|
Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| |
Collapse
|
9
|
Calthorpe L, Romero-Hernandez F, Casey M, Nunez M, Conroy PC, Hirose K, Kim A, Kirkwood K, Maker AV, Corvera C, Nakakura E, Alseidi A, Adam MA. National Practice Patterns in Malignant Peritoneal Mesothelioma: Updates in Management and Survival. Ann Surg Oncol 2023; 30:5119-5129. [PMID: 37140748 DOI: 10.1245/s10434-023-13528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare malignancy with a historically poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective therapy for patients with peritoneal malignancies. A contemporary analysis of trends in management of and survival from MPM is warranted. METHODS Patients with MPM were identified from the National Cancer Database (2004-2018). Patients were categorized by treatment (CRS-HIPEC, CRS-chemotherapy, CRS only, chemotherapy only, no treatment), and joinpoint regression was employed to compute the annual percent change (APC) in treatment over time. Multivariable Cox proportional hazards models were used to analyze factors associated with survival. RESULTS Of 2683 patients with MPM, 19.1% underwent CRS-HIPEC, and 21.1% received no treatment. Joinpoint regression revealed a statistically significant increase in the proportion of patients undergoing CRS-HIPEC over time (APC 3.21, p = 0.01), and a concurrent decrease in the proportion of patients who underwent no treatment (APC - 2.21, p = 0.02). Median overall survival was 19.5 months. Factors independently associated with survival included CRS-HIPEC, CRS, histology, sex, age, race, Charlson Comorbidity Index, insurance, and hospital type. Although there was a strong association between year of diagnosis and survival on univariate analysis (2016-2018 HR 0.67, p < 0.001), this association was attenuated after adjustment for treatment. CONCLUSIONS CRS-HIPEC is increasingly employed as a treatment for MPM. In parallel, there has been a decrease in patients receiving no treatment with an increase in overall survival. These findings suggest that patients with MPM may be receiving more appropriate therapy; however, a substantial proportion of patients may remain undertreated.
Collapse
Affiliation(s)
- Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Megan Casey
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Miguel Nunez
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Patricia C Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Kimberly Kirkwood
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed Abdelgadir Adam
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
10
|
Voigt W, Trautwein M. Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures? Curr Opin Oncol 2023; 35:68-77. [PMID: 36367223 DOI: 10.1097/cco.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Despite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine. RECENT FINDINGS Some studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability. SUMMARY In principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.
Collapse
Affiliation(s)
- Wieland Voigt
- Wieland Voigt, Medical Innovations and Management, Steinbeis University Berlin, Berlin
| | - Martin Trautwein
- Martin Trautwein, Senior Medical Advisor, Cognostics GmbH, Munich, Germany
| |
Collapse
|
11
|
Camp DM, Moore SJ, Wood-Palmer D, Doraivelu K, Holbrook NM, Byrd RN, Kalokhe AS, Ali MK, Farber EW, Hussen SA. Preferences of Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Regarding Integration of HIV and Mental Health Care Services. AIDS Patient Care STDS 2022; 36:356-363. [PMID: 36037013 PMCID: PMC9514599 DOI: 10.1089/apc.2022.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Optimization of mental health service use is critical to HIV care engagement among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM). Clinic-level interventions to integrate HIV and mental health services have been proposed; however, patient perspectives on such care models are often lacking. We conducted a mixed-methods study consisting of surveys (N = 100) and qualitative in-depth interviews (n = 15) with YB-GBMSM recruited from two Ryan White-funded HIV clinics in Atlanta, Georgia. Most participants (70%) agreed that integration of HIV and mental health services was beneficial to them. Thirty-six percent (36%) desired a higher level of integration than what they perceived was currently available in their clinic setting, 51% believed their clinic was already optimally integrated, and 13% preferred less integration. In the qualitative interviews, participants discussed their support for potential integration strategies such as training HIV providers to prescribe antidepressants, closer in-clinic proximity of HIV and mental health providers, and use of patient navigators to help patients access mental health care and remind them of appointments. Perceived benefits of care integration included easier access to mental health services, enhanced overall well-being, and improved HIV care engagement. In summary, YB-GBMSM were supportive of integrating HIV and mental health services, with varying individual preferences regarding the degree and operationalization of this integration. Improving integration of mental health and HIV services, and tailoring modes of service delivery to individual preferences, has the potential to improve both general well-being and HIV care engagement in this high priority population.
Collapse
Affiliation(s)
- Daniel M. Camp
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Shamia J. Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Drew Wood-Palmer
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | | | - Ameeta S. Kalokhe
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eugene W. Farber
- Infectious Disease Program (Ponce Center), Grady Health System, Atlanta, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Infectious Disease Program (Ponce Center), Grady Health System, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Patel MI, Ferguson JM, Castro E, Pereira-Estremera CD, Armaiz-Peña GN, Duron Y, Hlubocky F, Infantado A, Nuqui B, Julian D, Nortey N, Steck A, Bondy M, Maingi S. Racial and Ethnic Disparities in Cancer Care During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2222009. [PMID: 35834248 PMCID: PMC9284331 DOI: 10.1001/jamanetworkopen.2022.22009] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE The full effect of the COVID-19 pandemic on cancer care disparities, particularly by race and ethnicity, remains unknown. OBJECTIVES To assess whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays, adverse social and economic effects, and concerns during the COVID-19 pandemic and to evaluate trusted sources of COVID-19 information by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This national survey study of US adults with cancer compared treatment delays, adverse social and economic effects, concerns, and trusted sources of COVID-19 information by race and ethnicity from September 1, 2020, to January 12, 2021. EXPOSURES The COVID-19 pandemic. MAIN OUTCOMES AND MEASURES The primary outcome was delay in cancer treatment by race and ethnicity. Secondary outcomes were duration of delay, adverse social and economic effects, concerns, and trusted sources of COVID-19 information. RESULTS Of 1639 invited respondents, 1240 participated (75.7% response rate) from 50 US states, the District of Columbia, and 5 US territories (744 female respondents [60.0%]; median age, 60 years [range, 24-92 years]; 266 African American or Black [hereafter referred to as Black] respondents [21.5%]; 186 Asian respondents [15.0%]; 232 Hispanic or Latinx [hereafter referred to as Latinx] respondents [18.7%]; 29 American Indian or Alaska Native, Native Hawaiian, or multiple races [hereafter referred to as other] respondents [2.3%]; and 527 White respondents [42.5%]). Compared with White respondents, Black respondents (odds ratio [OR], 6.13 [95% CI, 3.50-10.74]) and Latinx respondents (OR, 2.77 [95% CI, 1.49-5.14]) had greater odds of involuntary treatment delays, and Black respondents had greater odds of treatment delays greater than 4 weeks (OR, 3.13 [95% CI, 1.11-8.81]). Compared with White respondents, Black respondents (OR, 4.32 [95% CI, 2.65-7.04]) and Latinx respondents (OR, 6.13 [95% CI, 3.57-10.53]) had greater odds of food insecurity and concerns regarding food security (Black respondents: OR, 2.02 [95% CI, 1.34-3.04]; Latinx respondents: OR, 2.94 [95% CI, [1.86-4.66]), financial stability (Black respondents: OR, 3.56 [95% CI, 1.79-7.08]; Latinx respondents: OR, 4.29 [95% CI, 1.98-9.29]), and affordability of cancer treatment (Black respondents: OR, 4.27 [95% CI, 2.20-8.28]; Latinx respondents: OR, 2.81 [95% CI, 1.48-5.36]). Trusted sources of COVID-19 information varied significantly by race and ethnicity. CONCLUSIONS AND RELEVANCE In this survey of US adults with cancer, the COVID-19 pandemic was associated with treatment delay disparities and adverse social and economic effects among Black and Latinx adults. Partnering with trusted sources may be an opportunity to overcome such disparities.
Collapse
Affiliation(s)
- Manali I. Patel
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jacqueline M. Ferguson
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Eida Castro
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | | | - Guillermo N. Armaiz-Peña
- Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Ysabel Duron
- The Latino Cancer Institute, San Jose, California
| | - Fay Hlubocky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Bles Nuqui
- St Peter’s Health Partners Cancer Care, Albany, New York
| | - Donna Julian
- St Peter’s Health Partners Cancer Care, Albany, New York
| | - Nii Nortey
- St Peter’s Health Partners Cancer Care, Albany, New York
| | | | - Melissa Bondy
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Shail Maingi
- Dana Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
13
|
The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer. PLoS One 2022; 17:e0263818. [PMID: 35176030 PMCID: PMC8853572 DOI: 10.1371/journal.pone.0263818] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Black patients and underinsured patients with colorectal cancer (CRC) present with more advanced disease and experience worse outcomes. The study aim was to evaluate the interaction of health insurance status and race with treatment and survival in metastatic CRC.
Materials and methods
Patients diagnosed with metastatic CRC within NCDB from 2006–2016 were included. Primary outcomes included receipt of chemotherapy and 3-year all-cause mortality. Multivariable logistic regression and Cox-regression (MVR) including a two-way interaction term of race and insurance were performed to evaluate the differential association of race and insurance with receipt of chemotherapy and mortality, respectively.
Results
128,031 patients were identified; 70.6% White, 14.4% Black, 5.7% Hispanic, and 9.3% Other race. Chemotherapy use was higher among White compared to Black patients. 3-year mortality rate was higher for Blacks and lower for Hispanics, in comparison with White patients. By MVR, Black patients were less likely to receive chemotherapy. When stratified by insurance status, Black patients with private and Medicare insurance were less likely to receive chemotherapy than White patients. All-cause mortality was higher in Black patients and lower in Hispanic patients, and these differences persisted after controlling for insurance and receipt of chemotherapy.
Conclusion
Black patients and uninsured or under-insured patients with metastatic CRC are less likely to receive chemotherapy and have increased mortality. The effect of health insurance among Blacks and Whites differs, however, and improving insurance alone does not appear to fully mitigate racial disparities in treatment and outcomes.
Collapse
|
14
|
Amado GC, Ferreira DC, Nunes AM. Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment? Int J Health Plann Manage 2022; 37:1252-1298. [PMID: 34981855 DOI: 10.1002/hpm.3407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/27/2021] [Accepted: 12/09/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. OBJECTIVES This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. METHODS We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. RESULTS A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. CONCLUSIONS In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.
Collapse
Affiliation(s)
- Guilherme C Amado
- Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo C Ferreira
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Alexandre M Nunes
- Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
15
|
Nugus P, Travaglia J, MacGinley M, Colliver D, Mazaniello-Chezol M, Claudio F, Lewis LD. Conceptual foundations of organizational structure: re-structuring of women's health services. J Health Organ Manag 2021; ahead-of-print. [PMID: 34894117 DOI: 10.1108/jhom-09-2021-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.
Collapse
Affiliation(s)
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Haymarket, Australia
| | | | | | | | | | | |
Collapse
|
16
|
Golla V, Kaye DR. The Impact of Health Delivery Integration on Cancer Outcomes. Surg Oncol Clin N Am 2021; 31:91-108. [PMID: 34776068 DOI: 10.1016/j.soc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although integrated health care has largely been associated with increases in prices and static or decreased quality across many disease states, it has shown some successes in improving cancer care. However, its impact is largely equivocal, making consensus statements difficult. Critically, integration does not necessarily translate to clinical coordination, which might be the true driver behind the success of integrated health care delivery. Moving forward, it is important to establish payment models that support clinical care coordination. Shifting from a fragmented health system to a coordinated one may improve evidence-based cancer care, outcomes, and value for patients.
Collapse
Affiliation(s)
- Vishnukamal Golla
- Duke National Clinician Scholars Program, 200 Morris St, Suite 3400, DUMC Box 104427, Durham, NC 27701, USA; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center; Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center
| |
Collapse
|
17
|
Colorectal cancer in 18- to 49-year-olds: rising rates, presentation, and outcome in a large integrated health system. Gastrointest Endosc 2021; 94:618-626. [PMID: 33794247 DOI: 10.1016/j.gie.2021.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) rates are increasing in young people, and new guidelines recommend screening should begin at age 45 years. We aimed to evaluate CRC detection rates in a large integrated healthcare system to assess treatment outcomes in younger CRC patients and to determine factors that could aid in identifying these individuals. METHODS We analyzed confirmed cases of CRC using a cancer database spanning from 1985 to 2017 from a large integrated healthcare system composed of 15 hospitals, 150 outpatient clinics, and 20 outpatient oncology clinics. Three cohorts were evaluated (18-44 years, 45-49 years, and ≥50 years). RESULTS Significant increases in CRC detection were seen in the cohort aged 18 to 44 (annual percentage change, 2.70%) and the cohort aged 45 to 49 (annual percentage change, 4.15%). A higher proportion of African American, Hispanic, and obese subjects were seen in the younger cohorts. A family history of CRC was found in 49% of patients aged 18 to 44 and 38% of patients aged 45 to 50. Patients younger than age 50 were more likely to have metastases at diagnosis (6.8%) versus the cohort over 50 (4.15%; P < .05). Survival was better in younger cohorts, and they were more likely to receive multimodality treatment (surgery with chemotherapy or radiation). Survival probability was similar in different ethnic groups. CONCLUSIONS CRC is increasing at similar rates in young people aged 18 to 44 and 45 to 49, and they are more likely to present with advanced disease needing multimodality treatment. A family history identifies some patients <50 years. Young patients presenting with changes in bowel habit, rectal bleeding, anemia, and weight loss should undergo colonoscopy. Rectal and anal symptoms should prompt careful physical and endoscopic evaluation.
Collapse
|
18
|
Alfano CM, Mayer DK, Beckjord E, Ahern DK, Galioto M, Sheldon LK, Klesges LM, Aronoff-Spencer E, Hesse BW. Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy. JCO Clin Cancer Inform 2021; 4:539-546. [PMID: 32543897 DOI: 10.1200/cci.20.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.
Collapse
Affiliation(s)
| | | | - Ellen Beckjord
- Population Health and Clinical Affairs, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David K Ahern
- Brigham and Women's Hospital, Boston, MA.,Connect2Health Task Force, Federal Communications Commission, Washington DC
| | - Michele Galioto
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | - Lisa K Sheldon
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | | | - Eliah Aronoff-Spencer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | |
Collapse
|
19
|
Nizam W, Yeo HL, Obeng-Gyasi S, Brock MV, Johnston FM. Disparities in Surgical Oncology: Management of Advanced Cancer. Ann Surg Oncol 2021; 28:8056-8073. [PMID: 34268636 DOI: 10.1245/s10434-021-10275-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Significant variations in the patterns of care, incidence, and mortality rates of several common cancers have been noted. These disparities have been attributed to a complex interplay of factors, including genetic, environmental, and healthcare-related components. Within this review, primarily focusing on commonly occurring cancers (breast, lung, colorectal), we initially summarize the burden of these disparities with regard to incidence and screening patterns. We then explore the interaction between several proven genetic, epigenetic, and environmental influences that are known to contribute to these disparities.
Collapse
Affiliation(s)
- Wasay Nizam
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Heather L Yeo
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. .,Division of Gastrointestinal Surgical Oncology, Peritoneal Surface Malignancy Program, Complex General Surgical Oncology Fellowship, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
20
|
Doose M, Sanchez JI, Cantor JC, Plascak JJ, Steinberg MB, Hong CC, Demissie K, Bandera EV, Tsui J. Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems. JCO Oncol Pract 2021; 17:e637-e644. [PMID: 33974834 DOI: 10.1200/op.20.01089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer-accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (P > .05). CONCLUSION The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.
Collapse
Affiliation(s)
- Michelle Doose
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.,Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janeth I Sanchez
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ
| | | | | | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY.,Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jennifer Tsui
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
21
|
Mefford MT, Zhuang Z, Liang Z, Chen W, Koyama SY, Taitano MT, Watson HL, Lee MS, Sidney S, Reynolds K. Temporal trends in heart failure mortality in an integrated healthcare delivery system, California, and the US, 2001-2017. BMC Cardiovasc Disord 2021; 21:261. [PMID: 34039262 PMCID: PMC8157708 DOI: 10.1186/s12872-021-02075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, decreases in mortality rates attributable to cardiovascular diseases have slowed but mortality attributable to heart failure (HF) has increased. METHODS Between 2001-2017, trends in age-adjusted mortality with HF as an underlying cause for Kaiser Permanente Southern California (KPSC) members were derived through linkage with state death files and compared with trends among California residents and the US. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated using Joinpoint regression. Analyses were repeated examining HF as a contributing cause of death. RESULTS In KPSC, the age-adjusted HF mortality rates were comparable to California but lower than the US, increasing from 23.9 per 100,000 person-years (PY) in 2001 to 44.7 per 100,000 PY in 2017, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). HF mortality also increased in California from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI - 0.5%, 0.5%). Trends among KPSC members ≥ 65 years old were similar to the overall population, while trends among members 45-64 years old were flat between 2001-2017. Small changes in mortality with HF as a contributing cause were observed in KPSC members between 2001 and 2017, which differed from California and the US. CONCLUSION Lower rates of HF mortality were observed in KPSC compared to the US. Given the aging of the US population and increasing prevalence of HF, it will be important to examine individual and care-related factors driving susceptibility to HF mortality.
Collapse
Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
| | - Zimin Zhuang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Zhi Liang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Sandra Y Koyama
- Internal Medicine, Kaiser Permanente Southern California, Baldwin Park, CA, USA
| | | | - Heather L Watson
- Complete Care Support Programs, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| |
Collapse
|
22
|
Schneider JL, Feigelson HS, Quinn VP, McMullen C, Pawloski PA, Powers JD, Sterrett AT, Arterburn D, Corley DA. Variation in Colorectal Cancer Stage and Mortality across Large Community-Based Populations: PORTAL Colorectal Cancer Cohort. Perm J 2020; 24:19.182. [PMID: 33183496 DOI: 10.7812/tpp/19.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality can be reduced by effective screening and/or treatment. However, the influence of health care systems on disparities among insured patients is largely unexplored. METHODS To evaluate insured patients with CRC diagnosed between 2010 and 2014 across 6 diverse US health care systems in the Patient-Centered Outcomes Research Institute (PCORI) Patient Outcomes Research To Advance Learning (PORTAL) CRC cohort, we contrasted CRC stage; CRC mortality; all-cause mortality; and influences of demographics, stage, comorbidities, and treatment between health systems. RESULTS Among 16,211 patients with CRC, there were significant differences between health care systems in CRC stage at diagnosis, CRC-specific mortality, and all-cause mortality. The unadjusted risk of CRC mortality varied from 27% lower to 21% higher than the reference system (hazard ratio [HR] = 0.73, 95% confidence interval = 0.66-0.80 to HR = 1.21, 95% confidence interval = 1.05-1.40; p < 0.01 across systems). Significant differences persisted after adjustment for demographics and comorbidities (p < 0.01); however, adjustment for stage eliminated significant differences (p = 0.24). All-cause mortality among patients with CRC differed approximately 30% between health care systems (HR = 0.89-1.17; p < 0.01). Adjustment for age eliminated significant differences (p = 0.48). DISCUSSION Differences in CRC survival between health care systems were largely explained by stage at diagnosis, not demographics, comorbidity, or treatment. Given that stage is strongly related to early detection, these results suggest that variation in CRC screening systems represents a modifiable systems-level factor for reducing disparities in CRC survival.
Collapse
Affiliation(s)
| | | | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | | | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
| |
Collapse
|
23
|
Racial and Socioeconomic Disparities in the Treatments and Outcomes of Pancreatic Cancer Among Different Treatment Facility Types. Pancreas 2020; 49:1355-1363. [PMID: 33122525 DOI: 10.1097/mpa.0000000000001688] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate racial and socioeconomic disparities for patients with pancreatic cancer across different facility types. METHODS The National Cancer Database was queried for pancreatic cancer cases from 2004 to 2015. Along with propensity score matching analysis, multivariate logistic and Cox model were used to assess effects of facility type, race, elements of socioeconomics on receipt of treatment, time to treatment, and overall survival, separately. RESULTS Among 223,465 patients, 44.6%, 42.1%, and 13.3% were treated at academic, community, and integrated facilities, respectively. Private insurance was associated with more treatment (odds ratio, 1.41; P < 0.001) and better survival [hazards ratio (HR), 0.84; P < 0.001]. Higher education was associated with earlier treatment (HR, 1.09; P < 0.001). African Americans had less treatment (odds ratio, 0.97; P = 0.04) and delayed treatment (HR, 0.89; P < 0.001) despite later stage at diagnosis. After adjusting for socioeconomic status, African Americans had similar survival (HR, 0.99; P = 0.11) overall and improved survival (HR, 0.95; P = 0.016) at integrated facilities. CONCLUSIONS Higher socioeconomic status was associated with better treatment and survival. After adjusting for socioeconomic disparities, race did not affect survival. Less racial disparity was observed at integrated facilities.
Collapse
|
24
|
Liu W, Goodman M, Filson CP. Association of State-Level Medicaid Expansion With Treatment of Patients With Higher-Risk Prostate Cancer. JAMA Netw Open 2020; 3:e2015198. [PMID: 33026448 PMCID: PMC7542300 DOI: 10.1001/jamanetworkopen.2020.15198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The Patient Protection and Affordable Care Act broadened insurance coverage, partially through voluntary state-based Medicaid expansion. OBJECTIVE To determine whether patients with higher-risk prostate cancer residing in Medicaid expansion states were more likely to receive treatment after expansion compared with patients in states electing not to pursue Medicaid expansion. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 15 332 patients diagnosed with higher-risk prostate cancer (ie, grade group >2; grade group 2 with prostate-specific antigen levels >10 ng/mL; or grade group 1 with prostate-specific antigen levels >20 ng/mL) from January 2010 to December 2016 aged 50 to 64 years who were candidates for definitive treatment. Patients residing in states that partially expanded Medicaid coverage before 2010 (ie, California and Connecticut) and those with diagnosis not confirmed by histology were excluded. Data were collected from the Surveillance, Epidemiology, and End Results Program. Data were analyzed between August and December 2019. EXPOSURE State-level Medicaid expansion status. MAIN OUTCOMES AND MEASURES Insurance status before and after expansion, treatment with prostatectomy or radiation therapy (including brachytherapy), treatment trends over time. RESULTS Of 15 332 patients, 7811 (50.9%) lived in expansion states (mean [SD] age, 59.1 [3.8] years; 5532 [71.9%] non-Hispanic White), and 7521 (49.1%) lived in nonexpansion states (mean [SD] age, 59.0 [3.9] years; 3912 [52.1%] non-Hispanic White). Residence in an expansion state was associated with higher pre-expansion levels of Medicaid coverage (292 [8.1%] vs 161 [3.8%]; odds ratio [OR], 2.12; 95% CI, 1.78 to 2.53) and lower likelihood of being uninsured (136 [3.2%] vs 38 [1.1%]; OR, 0.28; 95% CI, 0.15 to 0.54). After expansion, there was no difference in trends in treatment receipt between expansion and nonexpansion states (change, -0.39%; 95% CI, -0.11% to 0.28%; P = .25). Patients with private or Medicare coverage were more likely to receive treatment vs those with Medicaid or no coverage across racial/ethnic groups (eg, Black patients with coverage: OR, 2.30; 95% CI, 1.68 to 3.10; Black patients with no coverage: OR, 1.48; 95% CI, 1.09 to 2.00; P < .001). Medicaid patients were not more likely to be treated compared with those without insurance (737 [78.8%] vs 435 [79.5%]; OR, 0.97; 95% CI, 0.76 to 1.25). CONCLUSIONS AND RELEVANCE In this cohort study, state-level expansion of Medicaid was associated with increased Medicaid coverage for men with higher-risk prostate tumors but did not appear to affect treatment patterns at a population level. This may be related to the finding that Medicaid coverage was not associated with increased treatment rates compared with those without insurance.
Collapse
Affiliation(s)
- Wen Liu
- Department of Urology, NYU Langone School of Medicine, New York, New York
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Christopher P. Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
| |
Collapse
|
25
|
Smith LB, Desai NR, Dowd B, Everhart A, Herrin J, Higuera L, Jeffery MM, Jena AB, Ross JS, Shah ND, Karaca-Mandic P. Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:299-317. [PMID: 32350680 PMCID: PMC7725279 DOI: 10.1007/s10754-020-09282-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, we examine changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial). We examine the patient and provider characteristics associated with a decline in use of these medications. Using Medicare fee-for-service claims from 2008 to 2013, we identified two cohorts: patients with Type 2 diabetes using statins (7 million patient-quarters), and patients with permanent atrial fibrillation (83 thousand patient-quarters). We used interrupted time-series regression models to identify the patient- and provider-level characteristics associated with changes in medication use after new evidence emerged for each case. After new evidence of ineffectiveness emerged, fenofibrate use declined by 0.01 percentage points per quarter (95% CI - 0.02 to - 0.01) from a baseline of 6.9 percent of all diabetes patients receiving fenofibrate; dronedarone use declined by 0.13 percentage points per quarter (95% CI - 0.15 to - 0.10) from a baseline of 3.8 percent of permanent atrial fibrillation patients receiving dronedarone. For dronedarone, use declined more quickly among patients dually-enrolled in Medicare and Medicaid compared to Medicare-only patients (P < 0.001), among patients seen by male providers compared to female providers (P = 0.01), and among patients seen by cardiologists compared to primary care providers (P < 0.001).
Collapse
Affiliation(s)
- Laura Barrie Smith
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Nihar R Desai
- Cardiovascular Medicine, Yale School of Medicine, New Haven, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
| | - Bryan Dowd
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Alexander Everhart
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Jeph Herrin
- Cardiovascular Medicine, Yale School of Medicine, New Haven, USA
| | - Lucas Higuera
- Health Economics and Outcomes Research - Cardiac Rhythm and Heart Failure, Medtronic, Minneapolis, USA
| | - Molly Moore Jeffery
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
- Emergency Medicine Research, Mayo Clinic, Rochester, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, USA
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
- General Internal Medicine, Yale School of Medicine, New Haven, USA
- Health Policy and Management, Yale School of Public Health, New Haven, USA
| | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Pinar Karaca-Mandic
- National Bureau of Economic Research, Cambridge, MA, USA.
- Carlson School of Management, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
26
|
A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes. Health Care Manage Rev 2020; 44:159-173. [PMID: 29613860 DOI: 10.1097/hmr.0000000000000197] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Small independent practices are increasingly giving way to more complex affiliations between provider organizations and hospital systems. There are several ways in which vertically integrated health systems could improve quality and lower the costs of care. But there are also concerns that integrated systems may increase the price and costs of care without commensurate improvements in quality and outcomes. PURPOSE Despite a growing body of research on vertically integrated health systems, no systematic review that we know of compares vertically integrated health systems (defined as shared ownership or joint management of hospitals and physician practices) to nonintegrated hospitals or physician practices. METHODS We conducted a systematic search of the literature published from January 1996 to November 2016. We considered articles for review if they compared the performance of a vertically integrated health system and examined an outcome related to quality of care, efficiency, or patient-centered outcomes. RESULTS Database searches generated 7,559 articles, with 29 articles included in this review. Vertical integration was associated with better quality, often measured as optimal care for specific conditions, but showed either no differences or lower efficiency as measured by utilization, spending, and prices. Few studies evaluated a patient-centered outcome; among those, most examined mortality and did not identify any effects. Across domains, most studies were observational and did not address the issue of selection bias. PRACTICE IMPLICATIONS Recent evidence suggests the trend toward vertical integration will likely continue as providers respond to changing payment models and market factors. A growing body of research on comparative health system performance suggests that integration of physician practices with hospitals might not be enough to achieve higher-value care. More information is needed to identify the health system attributes that contribute to improved outcomes, as well as which policy levers can minimize anticompetitive effects and maximize the benefits of these affiliations.
Collapse
|
27
|
Patel MI, Khateeb S, Coker T. A randomized trial of a multi-level intervention to improve advance care planning and symptom management among low-income and minority employees diagnosed with cancer in outpatient community settings. Contemp Clin Trials 2020; 91:105971. [PMID: 32145441 DOI: 10.1016/j.cct.2020.105971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Equitable delivery of advance care planning and symptom management among patients is crucial to improving cancer care. Existing interventions to improve the uptake of these services have predominantly occurred in clinic settings and are limited in their effectiveness, particularly among low-income and minority populations. METHODS The "Lay health worker Educates Engages and Activates Patients to Share (LEAPS)" intervention was developed to improve advance care planning and symptom management among low-income and minority hourly-wage workers with cancer, in two community settings. The intervention provides a lay health worker to all patients newly diagnosed with cancer and aims to educate and activate patients to engage in advance care planning and symptom management with their oncology providers. In this randomized clinical trial, we will evaluate the effect on quality of life (primary outcome) using the validated Functional Assessment of Cancer Therapy - General Survey, at enrollment, 4- and 12- months post-enrollment. We will examine between-group differences on our secondary outcomes of patient activation, patient satisfaction with healthcare decision-making, and symptom burden (at enrollment, 4- and 12-months post-enrollment), and total healthcare use and healthcare costs (at 12-months post-enrollment). DISCUSSION Multilevel approaches are urgently needed to improve cancer care delivery among low-income and minority patients diagnosed with cancer in community settings. The current study describes the LEAPS intervention, the study design, and baseline characteristics of the community centers participating in the study. ClinicalTrials.gov Registration #NCT03699748.
Collapse
Affiliation(s)
- Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, CA, United States of America; Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America; Center for Primary Care and Outcomes Research/Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States of America.
| | - Sana Khateeb
- Division of Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Tumaini Coker
- Seattle Children's Research Institute, Seattle, WA, United States of America; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States of America
| |
Collapse
|
28
|
Liang PS, Mayer JD, Wakefield J, Trinh-Shevrin C, Kwon SC, Sherman SE, Ko CW. Trends in Sociodemographic Disparities in Colorectal Cancer Staging and Survival: A SEER-Medicare Analysis. Clin Transl Gastroenterol 2020; 11:e00155. [PMID: 32352722 PMCID: PMC7145046 DOI: 10.14309/ctg.0000000000000155] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/13/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Race, ethnicity, and socioeconomic status are known to influence staging and survival in colorectal cancer (CRC). It is unclear how these relationships are affected by geographic factors and changes in insurance coverage for CRC screening. We examined the temporal trends in the association between sociodemographic and geographic factors and staging and survival among Medicare beneficiaries. METHODS We identified patients 65 years or older with CRC using the 1991-2010 Surveillance, Epidemiology, and End Results-Medicare database and extracted area-level sociogeographic data. We constructed multinomial logistic regression models and the Cox proportional hazards models to assess factors associated with CRC stage and survival in 4 periods with evolving reimbursement and screening practices: (i) 1991-1997, (ii) 1998-June 2001, (iii) July 2001-2005, and (iv) 2006-2010. RESULTS We observed 327,504 cases and 102,421 CRC deaths. Blacks were 24%-39% more likely to present with distant disease than whites. High-income areas had 7%-12% reduction in distant disease. Compared with whites, blacks had 16%-21% increased mortality, Asians had 32% lower mortality from 1991 to 1997 but only 13% lower mortality from 2006 to 2010, and Hispanics had 20% reduced mortality only from 1991 to 1997. High-education areas had 9%-12% lower mortality, and high-income areas had 5%-6% lower mortality after Medicare began coverage for screening colonoscopy. No consistent temporal trends were observed for the associations between geographic factors and CRC survival. DISCUSSION Disparities in CRC staging and survival persisted over time for blacks and residents from areas of low socioeconomic status. Over time, staging and survival benefits have decreased for Asians and disappeared for Hispanics.
Collapse
Affiliation(s)
- Peter S. Liang
- Department of Medicine, NYU School of Medicine, New York, New York, USA
- Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Jonathan D. Mayer
- Departments of Epidemiology and Medical Geography, University of Washington, Seattle, Washington, USA
| | - Jon Wakefield
- Departments of Statistics and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Chau Trinh-Shevrin
- Department of Medicine, NYU School of Medicine, New York, New York, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Simona C. Kwon
- Department of Medicine, NYU School of Medicine, New York, New York, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Scott E. Sherman
- Department of Medicine, NYU School of Medicine, New York, New York, USA
- Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Cynthia W. Ko
- Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
29
|
Chen W, Yao J, Liang Z, Xie F, McCarthy D, Mingsum L, Reynolds K, Koebnick C, Jacobsen S. Temporal Trends in Mortality Rates among Kaiser Permanente Southern California Health Plan Enrollees, 2001-2016. Perm J 2020; 23:18-213. [PMID: 31050639 DOI: 10.7812/tpp/18-213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Temporal analyses of death rates in the US have found a decreasing trend in all-cause and major cause-specific mortality rates. OBJECTIVES To determine mortality trends in Kaiser Permanente Southern California (KPSC), a large insured population, and whether they differ from those of California and the US. METHODS Trends in age-adjusted all-cause and cause-specific mortality rates from 2001 to 2016 were determined using data collected in KPSC and those derived through linkage with California State death files and were compared with trends in the US and California. Trends of race/ethnicity-specific all-cause and cause-specific mortality rates were also examined. Average annual percent changes (AAPC) and 95% confidence intervals (CI) were calculated. RESULTS From 2001 to 2016, the age-adjusted all-cause mortality rate per 100,000 person-years decreased significantly in KPSC (AAPC = -1.84, 95% CI = -2.95 to -0.71), California (AAPC = -1.60, 95% CI = -2.51 to -0.69) and the US (AAPC = -1.10, 95% CI = -1.78 to -0.42). Rates of 2 major causes of death, cancer and heart disease, also decreased significantly in the 3 populations. Differences in trends of age-adjusted all-cause mortality rates and the top 10 cause-specific mortality rates between KPSC and California or the US were not statistically significant at the 95% level. No significant difference was found in the trends of race/ethnicity-specific, sex-specific, or race/ethnicity- and sex-specific all-cause mortality rates between KPSC and California or the US. CONCLUSION Trends in age-adjusted mortality rates in this insured population were comparable to those of the US and California.
Collapse
Affiliation(s)
- Wansu Chen
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Janis Yao
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Zhi Liang
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Fagen Xie
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Don McCarthy
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Lee Mingsum
- Department of Cardiology, Sunset Medical Center, Los Angeles, CA
| | - Kristi Reynolds
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Corinne Koebnick
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| | - Steven Jacobsen
- Kaiser Permanente Southern California Research and Evaluation, Pasadena
| |
Collapse
|
30
|
Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture? J Surg Res 2019; 246:123-130. [PMID: 31569034 DOI: 10.1016/j.jss.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.
Collapse
|
31
|
Kobayashi T, Glorioso TJ, Armstrong EJ, Maddox TM, Plomondon ME, Grunwald GK, Bradley SM, Tsai TT, Waldo SW, Rao SV, Banerjee S, Nallamothu BK, Bhatt DL, Rene AG, Wilensky RL, Groeneveld PW, Giri J. Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals. JAMA Cardiol 2019; 2:967-975. [PMID: 28724126 DOI: 10.1001/jamacardio.2017.2180] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. Objective To compare outcomes between black and white patients undergoing PCI in the VA health system. Design, Setting, and Participants This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Exposure Percutaneous coronary intervention at a VA hospital. Main Outcomes and Measures The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. Results A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36). Conclusions and Relevance While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.
Collapse
Affiliation(s)
- Taisei Kobayashi
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
| | - Thomas J Glorioso
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Ehrin J Armstrong
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver
| | - Thomas M Maddox
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Gary K Grunwald
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Steven M Bradley
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver
| | - Thomas T Tsai
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver
| | - Stephen W Waldo
- Veterans Affairs Eastern Colorado Healthcare System, Denver.,University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Consortium, Denver
| | - Sunil V Rao
- Durham Veterans Affairs Medical Center, Durham, North Carolina.,Duke University, Durham, North Carolina
| | - Subhash Banerjee
- Veterans Affairs North Texas Healthcare System, Dallas.,University of Texas Southwestern Medical Center, Dallas
| | - Brahmajee K Nallamothu
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan.,University of Michigan, Ann Arbor
| | - Deepak L Bhatt
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - A Garvey Rene
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
| | - Robert L Wilensky
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
| | - Peter W Groeneveld
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
| | - Jay Giri
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
| |
Collapse
|
32
|
Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations. Ann Surg 2019; 269:459-464. [DOI: 10.1097/sla.0000000000002695] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
33
|
Check DK, Albers KB, Uppal KM, Suga JM, Adams AS, Habel LA, Quesenberry CP, Sakoda LC. Examining the role of access to care: Racial/ethnic differences in receipt of resection for early-stage non-small cell lung cancer among integrated system members and non-members. Lung Cancer 2018; 125:51-56. [PMID: 30429038 PMCID: PMC6242353 DOI: 10.1016/j.lungcan.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the role of uniform access to care in reducing racial/ethnic disparities in receipt of resection for early stage non-small cell lung cancer (NSCLC) by comparing integrated health system member patients to demographically similar non-member patients. MATERIALS AND METHODS Using data from the California Cancer Registry, we conducted a retrospective cohort study of patients from four racial/ethnic groups (White, Black, Hispanic, Asian/Pacific Islander), aged 21-80, with a first primary diagnosis of stage I or II NSCLC between 2004 and 2011, in counties served by Kaiser Permanente Northern California (KPNC) at diagnosis. Our cohort included 1565 KPNC member and 4221 non-member patients. To examine the relationship between race/ethnicity and receipt of surgery stratified by KPNC membership, we used modified Poisson regression to calculate risk ratios (RR) adjusted for patient demographic and tumor characteristics. RESULTS Black patients were least likely to receive surgery regardless of access to integrated care (64-65% in both groups). The magnitude of the black-white difference in the likelihood of surgery receipt was similar for members (RR: 0.82, 95% CI: 0.73-0.93) and non-members (RR: 0.86, 95% CI: 0.80-0.94). Among members, roughly equal proportions of Hispanic and White patients received surgery; however, among non-members, Hispanic patients were less likely to receive surgery (non-members, RR: 0.93, 95% CI: 0.86-1.00; members, RR: 0.98, 95% CI: 0.89-1.08). CONCLUSION Disparities in surgical treatment for NSCLC were not reduced through integrated health system membership, suggesting that factors other than access to care (e.g., patient-provider communication) may underlie disparities. Future research should focus on identifying such modifiable factors.
Collapse
Affiliation(s)
- Devon K Check
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Kathleen B Albers
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Kanti M Uppal
- Vacaville Medical Center, Kaiser Permanente Northern California, 1 Quality Drive, Vacaville, CA, 95688, USA.
| | - Jennifer Marie Suga
- Vallejo Medical Center, Kaiser Permanente Northern California, 975 Sereno Drive, Vallejo, CA, 94589, USA.
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| |
Collapse
|
34
|
Ghai NR, Jensen CD, Corley DA, Doubeni CA, Schottinger JE, Zauber AG, Lee AT, Contreras R, Levin TR, Lee JK, Quinn VP. Colorectal Cancer Screening Participation Among Asian Americans Overall and Subgroups in an Integrated Health Care Setting with Organized Screening. Clin Transl Gastroenterol 2018; 9:186. [PMID: 30242160 PMCID: PMC6155113 DOI: 10.1038/s41424-018-0051-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 01/01/2023] Open
Abstract
Background Screening reduces colorectal cancer deaths, but <50% of Asian Americans are screening up-to-date according to surveys, with variability across Asian subgroups. We examined colorectal cancer screening participation among Asian Americans overall and Asian subgroups in a large integrated health care system with organized screening. Methods Data were electronically accessed to characterize screening in 2016 for Asians overall and subgroups relative to the National Colorectal Cancer Roundtable target of ≥80% screening and compared with non-Hispanic whites. Screening up-to-date was defined as a colonoscopy with 10 years, a sigmoidoscopy within 5 years, or a fecal immunochemical test (FIT) completed in 2016. Results Among 436,398 patients, 69,826 (16.0%) were Asian, of whom 79.8% were screening up-to-date vs. 77.6% of non-Hispanic whites (p < 0.001). Almost all subgroups met the 80% target: Chinese (83.3%), Vietnamese (82.4%), Korean (82.1%), other Asian (80.3%), Filipino (78.7%), Asian Indian (79.6%), and Japanese (79.0%). Among Asians overall and non-Hispanic whites, 50.6% and 48.4% of members were up-to-date with screening by colonoscopy, and 28.0% and 28.2% were up-to-date by FIT, respectively. Across Asian subgroups, colonoscopy most frequently accounting for being screening up-to-date (range: 47.4–59.7%), followed by FIT (range: 21.6–31.5%). Conclusions In an organized screening setting, there were minimal differences in screening participation among Asian subgroups and almost all met the 80% screening target, despite differences in language preference. Screening test type differences across subgroups suggest possible preferences in screening modality, which can inform future research into tailored education or outreach.
Collapse
Affiliation(s)
- Nirupa R Ghai
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA.
| | - Christopher D Jensen
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Douglas A Corley
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, The Perelman School of Medicine at the University of Pennsylvania, 51N 39th Street, Andrew Mutch Building, 7th Floor, Philadelphia, PA, 19104, USA
| | - Joanne E Schottinger
- Kaiser Permanente Southern California Regional Offices, 393 East Walnut Street, Pasadena, CA, 91188, USA
| | - Ann G Zauber
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2063A, New York, NY, 10017, USA
| | - Alexander T Lee
- Southern California Permanente Medical Group, Kaiser Permanente Woodland Hills, 5601 De Soto Ave, Woodland Hills, CA, 91365, USA
| | - Richard Contreras
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA
| | - Theodore R Levin
- Kaiser Permanente Medical Center, 1425 South Main Street, Walnut Creek, CA, 94596, USA
| | - Jeffrey K Lee
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Virginia P Quinn
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA
| |
Collapse
|
35
|
Borno HT, Zhang L, Siegel A, Chang E, Ryan CJ. At What Cost to Clinical Trial Enrollment? A Retrospective Study of Patient Travel Burden in Cancer Clinical Trials. Oncologist 2018; 23:1242-1249. [PMID: 29700209 DOI: 10.1634/theoncologist.2017-0628] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/14/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recent literature suggests that living in a rural setting may be associated with adverse cancer outcomes. This study examines the burden of travel from home to cancer center for clinical trial (CT) enrollees. MATERIALS AND METHODS Patients from the University of California San Francisco Clinical Trial Management System database who enrolled in a cancer CT for a breast, genitourinary, or gastrointestinal malignancy between 1993 and 2014 were included. Cancer type, household zip code, race/ethnicity, phase of study, study sponsor, and year of signed consent were exported. Distance traveled from home to center was calculated using a GoogleMaps application programming interface. The relationships of distance with phase of CT, household income, and race/ethnicity were examined. RESULTS A total of 1,600 patients were enrolled in breast (55.8%), genitourinary (29.4%), or gastrointestinal (14.9%) cancer CTs. The overall median unidirectional distance traveled from home to study site was 25.8 miles (interquartile range [IQR] 11.5-75.3). Of the trial sponsors examined, principal investigator (56.4%), industry (22.2%), cooperative group (11.6%), and National Institutes of Health (NIH; 9.8%), the longest distance traveled was for NIH-sponsored trials, with a median of 39.4 miles (p < .001). Phase I (8.4%) studies had the longest distance traveled, with a median of 41.2 miles (IQR 14.5-101.0 miles; p = .001). White patients (83%) traveled longer compared with black patients (4.4%), with median distances of 29.9 and 13.9 miles, respectively (p < .001). Patients from lower-income areas (n = 799) traveled longer distances compared with patients from higher-income areas (n = 773; 58.3 vs. 17.8 miles, respectively; p < .001). A multivariable linear model where log10 (distance) was the outcome and adjusting for the exported variables and income revealed that cancer type, year of consent, race/ethnicity, and income were significantly associated with distance traveled. CONCLUSION This study found that the burden of travel is highest among patients enrolled in NIH-sponsored trials, phase I studies, or living in low-income areas. These data suggest that travel burden for cancer CT participants may be significant. IMPLICATIONS FOR PRACTICE This study is one of the first to measure travel distance for patients in cancer clinical trials using a real-world GoogleMaps calculator. Out-of-pocket expenses such as travel are not typically covered by health care payers; therefore, patients may face considerable cost to attend each study visit. Using a single-center clinical trials enrollment database, this study found that the burden of travel is highest for patients enrolled in National Institutes of Health-sponsored trials and phase I studies, as well as for patients living in low-income areas. Results suggest that a significant proportion of patients enrolled in clinical trials face a substantial travel burden.
Collapse
Affiliation(s)
- Hala T Borno
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
| | - Li Zhang
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Adam Siegel
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
| | - Emily Chang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Charles J Ryan
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
36
|
Kauffmann RM, Hamner JB, Ituarte PHG, Yim JH. Age greater than 60 years portends a worse prognosis in patients with papillary thyroid cancer: should there be three age categories for staging? BMC Cancer 2018; 18:316. [PMID: 29566662 PMCID: PMC5865378 DOI: 10.1186/s12885-018-4181-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/06/2018] [Indexed: 02/08/2023] Open
Abstract
Background Age is an important prognostic factor in papillary thyroid cancer (PTC), with better survival observed in patients < 45 years of age, regardless of stage. Although the impact of increasing age on PTC-related survival is well-known, previous studies have focused on survival relative to age 45 years only. As the number of patients entering their 7th decade of life increases, PTC-related survival in this demographic becomes increasingly important. Survival in patients ≥ 60 years specifically compared to other groups has not previously been examined. We sought to determine whether age ≥ 60 years is an adverse prognostic factor for disease-specific survival and recurrence in patients with PTC. Methods The California Cancer Registry database was linked to inpatient and ambulatory patient records from the Office of Statewide Health Planning and Development for the years 2000–2011. This linked database was queried for patients diagnosed with papillary thyroid cancer and treated with surgery. We then identified prognostic factors related to both 5-year and 10-year disease-specific survival and disease-free survival in patients ≤ 45, 45–59, and ≥ 60 years. Multivariable Cox proportional hazard models were created to test the effect of age ≥ 60 on disease-specific and disease-free survival, controlling for clinical, treatment, and demographic factors. Results The final cohort included 15,675 patients. Of the group, 46.3% were between 18 and 44 years of age, 33.6% were 45–59 years, and 20.1% were ≥ 60. Univariate analysis showed that compared to other groups, patients ≥ 60 were more likely to be male (p < 0.001), present with tumors > 5 cm (p < 0.001), more likely to have metastatic disease (p < 0.001), less likely to receive radioactive iodine (p < 0.001), and more likely to receive external beam radiation therapy (p < 0.001). In multivariable Cox proportional hazards models for 5 and 10-year disease-free survival, age ≥ 60 was associated with higher risk of disease at 5 and 10-years (HR 2.3 and 1.9 respectively, p < 0.001). Similar results were observed for 5 and 10-year disease-specific survival (HR 38.0 and 30.0 respectively, p < 0.001) after controlling for gender, race, co-morbidity, stage, surgical procedure, radioactive iodine, insurance, and hospital volume. Conclusions Patients ≥ 60 years of age have worse DSS and DFS after a diagnosis of PTC, across all stages of disease. Given that patients over the age of 45 years have progressively worse survival as they age, these data support having three age groups, 18–44 years of age, 45–59 years, and ≥ 60 as an independent predictor of survival and recurrence to current staging guidelines.
Collapse
Affiliation(s)
- Rondi M Kauffmann
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - J Blair Hamner
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - Philip H G Ituarte
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA
| | - John H Yim
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA, 91010-8113, USA.
| |
Collapse
|
37
|
Abstract
As a nation, we underinvest in prevention and fail to implement strategies that ensure all population groups equitably share in the return on investment in prevention research and the benefits of prevention effectiveness. There is significant evidence indicating that by applying knowledge that we already have to reduce tobacco, inactivity, and obesity (known modifiable causes of cancer), we can prevent more than 50% of cancers. Vaccination against HPV, aspirin and selective estrogen receptor modulators, and screening programs further reduce risk. Evidence-based prevention strategies are inconsistently implemented across the United States. Substantial variation across States indicates that there is much room for improvement in implementation of prevention. Implementation science applies innovative approaches to identifying, understanding, and developing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines that will prevent cancer through application of evidence-based interventions. When we get implementation of prevention programs right and at scale, we achieve substantial population benefits. Although many efforts are underway to maximize our knowledge about the causes and treatments of cancer, we can achieve reductions in the cancer burden right now by doing what we already know. The time to start is now. Cancer Prev Res; 11(4); 171-84. ©2018 AACR.
Collapse
Affiliation(s)
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| |
Collapse
|
38
|
Abstract
OBJECTIVES The objective of this study was to evaluate whether disparities in pancreatic cancer diagnosis, treatment, and survival are reduced in an integrated health system. METHODS We conducted a retrospective study (2006-2014) among patients with pancreatic cancer from Kaiser Permanente Southern California. Racial ethnic groups included non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanics, and Asians. We used multivariable and Cox regression analyses to evaluate disparities in diagnosis and treatment utilization (oncology care, surgery, time to surgery, chemotherapy) and overall survival, respectively. RESULTS Among 2103 patients, 54% were diagnosed with stage IV disease, 80% received oncology consultation, 20% received surgery with mean time to surgery 27 days (standard deviation, 36.8), 50.4% received chemotherapy. Mean overall survival was 8.6 months (standard deviation, 11.5). There were no differences in odds of stage IV diagnosis, oncology consultation, surgery, or time to surgery by racial ethnic group. Asians were more likely to receive chemotherapy (odds ratio, 1.59; 95% confidence interval [CI], 1.09-2.32) compared to NHW. NHB (hazard ratio, 0.78; 95% CI, 0.67-0.91) and Asians (hazard ratio, 0.81; 95% CI, 0.66-1.00) had improved survival compared to NHW. CONCLUSIONS Minorities were not disadvantaged in pancreatic cancer care. Improved health care coordination may improve current disparities.
Collapse
|
39
|
Li J, Ye Z, Dupree JM, Hollenbeck BK, Min HS, Kaye D, Herrel LA, Miller DC, Ellimoottil C. Association of Delivery System Integration and Outcomes for Major Cancer Surgery. Ann Surg Oncol 2017; 25:856-863. [PMID: 29285642 DOI: 10.1245/s10434-017-6312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Integrated delivery systems (IDSs) are postulated to reduce spending and improve outcomes through successful coordination of care across multiple providers. Nonetheless, the actual impact of IDSs on outcomes for complex multidisciplinary care such as major cancer surgery is largely unknown. METHODS Using 2011-2013 Medicare data, this study identified patients who underwent surgical resection for prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, or ovarian cancer. Rates of readmission, 30-day mortality, surgical complications, failure to rescue, and prolonged hospital stay for cancer surgery were compared between patients receiving care at IDS hospitals and those receiving care at non-IDS hospitals. Generalized estimating equations were used to adjust results by cancer type and patient- and hospital-level characteristics while accounting for clustering of patients within hospitals. RESULTS The study identified 380,053 patients who underwent major resection of cancer, with 38% receiving care at an IDS. Outcomes did not differ between IDS and non-IDS hospitals regarding readmission and surgical complication rates, whereas only minor differences were observed for 30-day mortality (3.5% vs 3.2% for IDS; p < 0.001) and prolonged hospital stay (9.9% vs 9.2% for IDS; p < 0.001). However, after adjustment for patient and hospital characteristics, the frequencies of adverse perioperative outcomes were not significantly associated with IDS status. CONCLUSIONS The collective findings suggest that local delivery system integration alone does not necessarily have an impact on perioperative outcomes in surgical oncology. Moving forward, stakeholders may need to focus on surgical and oncology-specific methods of care coordination and quality improvement initiatives to improve outcomes for patients undergoing cancer surgery.
Collapse
Affiliation(s)
- Jonathan Li
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Zaojun Ye
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - James M Dupree
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brent K Hollenbeck
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Hye Sung Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Deborah Kaye
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey A Herrel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Chad Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
40
|
Polite BN, Adams-Campbell LL, Brawley OW, Bickell N, Carethers JM, Flowers CR, Foti M, Gomez SL, Griggs JJ, Lathan CS, Li CI, Lichtenfeld JL, McCaskill-Stevens W, Paskett ED. Charting the Future of Cancer Health Disparities Research: A Position Statement From the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. J Clin Oncol 2017; 35:3075-3082. [DOI: 10.1200/jco.2017.73.6546] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Blase N. Polite
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Lucile L. Adams-Campbell
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Otis W. Brawley
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Nina Bickell
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - John M. Carethers
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Christopher R. Flowers
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Margaret Foti
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Scarlett Lin Gomez
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Jennifer J. Griggs
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Christopher S. Lathan
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Christopher I. Li
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - J. Leonard Lichtenfeld
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Worta McCaskill-Stevens
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| | - Electra D. Paskett
- Blase N. Polite, The University of Chicago, Chicago, IL; Lucile L. Adams-Campbell, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Otis W. Brawley and J. Leonard Lichtenfeld, American Cancer Society; Christopher R. Flowers, Emory University, Atlanta, GA; Nina Bickell, Icahn Mount Sinai School of Medicine, New York, NY; John M. Carethers and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; Margaret Foti, American Association for Cancer Research, Philadelphia, PA; Scarlett Lin
| |
Collapse
|
41
|
Polite BN, Adams-Campbell LL, Brawley OW, Bickell N, Carethers JM, Flowers CR, Foti M, Gomez SL, Griggs JJ, Lathan CS, Li CI, Lichtenfeld JL, McCaskill-Stevens W, Paskett ED. Charting the future of cancer health disparities research: A position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. CA Cancer J Clin 2017; 67:353-361. [PMID: 28738442 DOI: 10.3322/caac.21404] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Blase N Polite
- Associate Professor of Medicine, Department of Medicine, The University of Chicago, Chicago, IL
| | - Lucile L Adams-Campbell
- Associate Director, Minority Health and Health Disparities Research, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Nina Bickell
- Professor of Medicine and General Internal Medicine, Icahn Mount Sinai School of Medicine, New York, NY
| | - John M Carethers
- Professor and Chair, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Christopher R Flowers
- Associate Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Margaret Foti
- Chief Executive Officer, American Association for Cancer Research, Philadelphia, PA
| | - Scarlett Lin Gomez
- Consulting Associate Professor, Department of Health Research and Policy, Cancer Prevention Institute of California, Fremont, CA
| | - Jennifer J Griggs
- Professor, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI
| | - Christopher S Lathan
- Assistant Professor of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Christopher I Li
- Research Associate Professor, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Worta McCaskill-Stevens
- Chief, Community Oncology and Prevention Trials Research Group, National Cancer Institute, Rockville, MD
| | - Electra D Paskett
- Professor of Cancer Research, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
42
|
Polite BN, Adams-Campbell LL, Brawley OW, Bickell N, Carethers JM, Flowers CR, Foti M, Gomez SL, Griggs JJ, Lathan CS, Li CI, Lichtenfeld JL, McCaskill-Stevens W, Paskett ED. Charting the Future of Cancer Health Disparities Research: A Position Statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. Cancer Res 2017; 77:4548-4555. [PMID: 28739629 DOI: 10.1158/0008-5472.can-17-0623] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Nina Bickell
- Icahn Mount Sinai School of Medicine, New York, New York
| | | | | | - Margaret Foti
- American Association for Cancer Research, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Tapan U, Lee SY, Weinberg J, Kolachalama VB, Francis J, Charlot M, Hartshorn K, Chitalia V. Racial differences in colorectal cancer survival at a safety net hospital. Cancer Epidemiol 2017; 49:30-37. [PMID: 28538169 DOI: 10.1016/j.canep.2017.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/20/2017] [Accepted: 05/07/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND While racial disparity in colorectal cancer survival have previously been studied, whether this disparity exists in patients with metastatic colorectal cancer receiving care at safety net hospitals (and therefore of similar socioeconomic status) is poorly understood. METHODS We examined racial differences in survival in a cohort of patients with stage IV colorectal cancer treated at the largest safety net hospital in the New England region, which serves a population with a majority (65%) of non-Caucasian patients. Data was extracted from the hospital's electronic medical record. Survival differences among different racial and ethnic groups were examined graphically using Kaplan-Meier analysis. A univariate cox proportional hazards model and a multivariable adjusted model were generated. RESULTS Black patients had significantly lower overall survival compared to White patients, with median overall survival of 1.9 years and 2.5 years respectively. In a multivariate analysis, Black race posed a significant hazard (HR 1.70, CI 1.01-2.90, p=0.0467) for death. Though response to therapy emerged as a strong predictor of survival (HR=0.4, CI=0.2-0.7, p=0.0021), it was comparable between Blacks and Whites. CONCLUSIONS Despite presumed equal access to healthcare and socioeconomic status within a safety-net hospital system, our results reinforce findings from previous studies showing lower colorectal cancer survival in Black patients, and also point to the importance of investigating other factors such as genetic and pathologic differences.
Collapse
Affiliation(s)
- Umit Tapan
- Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Shin Yin Lee
- Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jean Francis
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Marjory Charlot
- Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Kevan Hartshorn
- Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Vipul Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
| |
Collapse
|
44
|
Balasubramanian BA, Garcia MP, Corley DA, Doubeni CA, Haas JS, Kamineni A, Quinn VP, Wernli K, Zheng Y, Skinner CS. Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems. Medicine (Baltimore) 2017; 96:e6326. [PMID: 28296752 PMCID: PMC5369907 DOI: 10.1097/md.0000000000006326] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Previous research shows that patients in integrated health systems experience fewer racial disparities compared with more traditional healthcare systems. Little is known about patterns of racial/ethnic disparities between safety-net and non safety-net integrated health systems.We evaluated racial/ethnic differences in body mass index (BMI) and the Charlson comorbidity index from 3 non safety-net- and 1 safety-net integrated health systems in a cross-sectional study. Multinomial logistic regression modeled comorbidity and BMI on race/ethnicity and health care system type adjusting for age, sex, insurance, and zip-code-level incomeThe study included 1.38 million patients. Higher proportions of safety-net versus non safety-net patients had comorbidity score of 3+ (11.1% vs. 5.0%) and BMI ≥35 (27.7% vs. 15.8%). In both types of systems, blacks and Hispanics were more likely than whites to have higher BMIs. Whites were more likely than blacks or Hispanics to have higher comorbidity scores in a safety net system, but less likely to have higher scores in the non safety-nets. The odds of comorbidity score 3+ and BMI 35+ in blacks relative to whites were significantly lower in safety-net than in non safety-net settings.Racial/ethnic differences were present within both safety-net and non safety-net integrated health systems, but patterns differed. Understanding patterns of racial/ethnic differences in health outcomes in safety-net and non safety-net integrated health systems is important to tailor interventions to eliminate racial/ethnic disparities in health and health care.
Collapse
Affiliation(s)
- Bijal A. Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael P. Garcia
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chyke A. Doubeni
- Department of Family Medicine and Community Health, and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer S. Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | | | - Virginia P. Quinn
- Research & Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Yingye Zheng
- Department of Biostatistics and Biomathematics, Division of Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Celette Sugg Skinner
- Department of Clinical Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, TX
| |
Collapse
|
45
|
Gerhard RS, Patil D, Liu Y, Ogan K, Alemozaffar M, Jani AB, Kucuk ON, Master VA, Gillespie TW, Filson CP. Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology. Urol Oncol 2017; 35:250-256. [PMID: 28089387 DOI: 10.1016/j.urolonc.2016.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/29/2016] [Accepted: 12/06/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. METHODS We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012). Primary outcome was NDM (i.e., delayed/no treatment with prostatectomy/radiation therapy or androgen-deprivation monotherapy). Treating facilities were classified by quartiles of proportions of patients treated with advanced technology. Multivariable regression estimated odds of primary outcome based on race, insurance status, and facility-level technology use, and evaluated for interactions between these covariates. RESULTS Among 60,300 patients, 9,265 (15.4%) received NDM. This was more common among non-White men (P<0.001), Medicaid/uninsured patients (P<0.001), and those managed at facilities in the lowest quartile of technology use (25.1% vs. 11.0% highest, P<0.001). Though NDM was common among non-White men with Medicaid/no insurance treated at low-technology centers (43% vs. 10% White, private/Medicare, high-tech facility; adjusted odds ratios = 7.18, P<0.001), this was less likely if this group was managed at a high-tech hospital (22% vs. 43% low-tech, P<0.001). CONCLUSIONS Technology use at a facility correlates with high-quality prostate cancer care and is associated with diminished disparities based on insurance status and patient race. More research is required to characterize other facility-level factors explaining these findings.
Collapse
Affiliation(s)
| | | | - Yuan Liu
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Omer N Kucuk
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA; Atlanta Veterans Administration Medical Center, Decatur, GA.
| |
Collapse
|
46
|
Wrenn G, Kasiah F, Belton A, Dorvil S, Roberts K, Mcgregor B, Holden K. Patient and Practitioner Perspectives on Culturally Centered Integrated Care to Address Health Disparities in Primary Care. Perm J 2017; 21:16-018. [PMID: 28488990 PMCID: PMC5424592 DOI: 10.7812/tpp/16-018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Addressing the multifaceted health and mental health needs of ethnically and culturally diverse individuals is a challenge within the current health care system. Integrated care provides a promising approach to improve mental health treatment-seeking disparities; however, adaptation of care models to impact African Americans is lacking. Although resources to support engagement of diverse populations in depression care exist, little has been developed to tailor patient preferences in accessing and engaging mental health services that are integrated into primary care. OBJECTIVE Our research seeks to add a cultural focus to the existing literature concerning integrated health care models to help address depression and selected co-occurring chronic health conditions in primary care settings. METHODS Thirty-two adult patients of an integrated primary care clinic participated in focus groups discussing their individual health experiences. Nine health care practitioners/administrators from five different integrated practice settings in the Atlanta, GA, area participated in key informant interviews. MAIN OUTCOME MEASURES Transcripts were analyzed for key themes related to depression care, perceived unmet cultural needs, and desired adaptations. RESULTS Common themes emerged such as the importance of peer-support and community engagement as areas of patient interest. Participants had good knowledge in recognizing depressive symptoms but were less knowledgeable about treatment options and expectations of treatment. The administrative and practitioner perspective suggests that patient preferences are valued and perceived as valid. CONCLUSION It is critical that strategies and models are developed to improve health care among underserved minorities because current models offer variable efficacy among this population.
Collapse
Affiliation(s)
- Glenda Wrenn
- Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, GA.
| | - Fatima Kasiah
- Fellow in the Department of Child and Adolescent Psychiatry at the University of Alabama at Birmingham.
| | - Allyson Belton
- Associate Project Director at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, GA.
| | - Sheena Dorvil
- Student at the Emory University Rollins School of Public Health in Atlanta, GA.
| | - Kristin Roberts
- Research Assistant at the National Center for Primary Care at the Morehouse School of Medicine in Atlanta, GA.
| | - Brian Mcgregor
- Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, GA.
| | - Kisha Holden
- Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, GA.
| |
Collapse
|
47
|
Coughlin SS, Blumenthal DS, Seay SJ, Smith SA. Toward the Elimination of Colorectal Cancer Disparities Among African Americans. J Racial Ethn Health Disparities 2016; 3:555-564. [PMID: 27294749 PMCID: PMC4911324 DOI: 10.1007/s40615-015-0174-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the USA, race and socioeconomic status are well-known factors associated with colorectal cancer incidence and mortality rates. These are higher among blacks than whites and other racial/ethnic groups. METHODS In this article, we review opportunities to address disparities in colorectal cancer incidence, mortality, and survivorship among African Americans. RESULTS First, we summarize the primary prevention of colorectal cancer and recent advances in the early detection of the disease and disparities in screening. Then, we consider black-white disparities in colorectal cancer treatment and survival including factors that may contribute to such disparities and the important roles played by cultural competency, patient trust in one's physician, and health literacy in addressing colorectal cancer disparities, including the need for studies involving the use of colorectal cancer patient navigators who are culturally competent. CONCLUSION To reduce these disparities, intervention efforts should focus on providing high-quality screening and treatment for colorectal cancer and on educating African Americans about the value of diet, weight control, screening, and treatment. Organized approaches for delivering colorectal cancer screening should be accompanied by programs and policies that provide access to diagnostic follow-up and treatment for underserved populations.
Collapse
Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, One University Avenue, Kitson Hall 311A, Lowell, MA, 01854, USA.
| | - Daniel S Blumenthal
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Selina A Smith
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| |
Collapse
|
48
|
Mehta SJ, Jensen CD, Quinn VP, Schottinger JE, Zauber AG, Meester R, Laiyemo AO, Fedewa S, Goodman M, Fletcher RH, Levin TR, Corley DA, Doubeni CA. Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System. J Gen Intern Med 2016; 31:1323-1330. [PMID: 27412426 PMCID: PMC5071288 DOI: 10.1007/s11606-016-3792-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/16/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. OBJECTIVE To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. DESIGN Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004-2013). SUBJECTS A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004-2006), 654,633 during the first 3 years after implementation (2007-2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation. INTERVENTION A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. MAIN MEASURES Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. KEY RESULTS From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results. CONCLUSIONS In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.
Collapse
Affiliation(s)
- Shivan J Mehta
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Ann G Zauber
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Reinier Meester
- Erasmus University Medical Center (Erasmus MC), Rotterdam, Netherlands
| | - Adeyinka O Laiyemo
- Division of Gastroenterology, Howard University College of Medicine, Washington, DC, USA
| | - Stacey Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA
| | | | | | | | | | - Chyke A Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Gates 2 Pavilion, Philadelphia, PA, 19104, USA.
| |
Collapse
|
49
|
Burnett-Hartman AN, Mehta SJ, Zheng Y, Ghai NR, McLerran DF, Chubak J, Quinn VP, Skinner CS, Corley DA, Inadomi JM, Doubeni CA. Racial/Ethnic Disparities in Colorectal Cancer Screening Across Healthcare Systems. Am J Prev Med 2016; 51:e107-15. [PMID: 27050413 PMCID: PMC5030113 DOI: 10.1016/j.amepre.2016.02.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Racial/ethnic disparities in colorectal cancer (CRC) screening and diagnostic testing present challenges to CRC prevention programs. Thus, it is important to understand how differences in CRC screening approaches between healthcare systems are associated with racial/ethnic disparities. METHODS This was a retrospective cohort study of patients aged 50-75 years who were members of the Population-based Research Optimizing Screening Through Personalized Regimens cohort from 2010 to 2012. Data on race/ethnicity, CRC screening, and diagnostic testing came from medical records. Data collection occurred in 2014 and analysis in 2015. Logistic regression models were used to calculate AORs and 95% CIs comparing completion of CRC screening between racial/ethnic groups. Analyses were stratified by healthcare system to assess differences between systems. RESULTS There were 1,746,714 participants across four healthcare systems. Compared with non-Hispanic whites (whites), odds of completing CRC screening were lower for non-Hispanic blacks (blacks) in healthcare systems with high screening rates (AOR=0.86, 95% CI=0.84, 0.88) but similar between blacks and whites in systems with lower screening rates (AOR=1.01, 95% CI=0.93, 1.09). Compared with whites, American Indian/Alaskan Natives had lower odds of completing CRC screening across all healthcare systems (AOR=0.76, 95% CI=0.72, 0.81). Hispanics had similar odds of CRC screening (AOR=0.99, 95% CI=0.98, 1.00) and Asian/Pacific Islanders had higher odds of CRC screening (AOR=1.16, 95% CI=1.15, 1.18) versus whites. CONCLUSIONS Racial/ethnic differences in CRC screening vary across healthcare systems, particularly for blacks, and may be more pronounced in systems with intensive CRC screening approaches.
Collapse
Affiliation(s)
- Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Shivan J Mehta
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nirupa R Ghai
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | | | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Celette Sugg Skinner
- University of Texas Southwestern Medical Center and the Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - John M Inadomi
- Division of Gastroenterology, University of Washington, School of Medicine, Seattle, Washington
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
50
|
Muoto I, Luck J, Yoon J, Bernell S, Snowden JM. Oregon’s Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities. Health Aff (Millwood) 2016; 35:1625-32. [DOI: 10.1377/hlthaff.2016.0396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ifeoma Muoto
- Ifeoma Muoto ( ) is an Administrative Fellow at Kaiser Permanente, Southern California Region, in Harbor City, California. She was a doctoral candidate in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, at Oregon State University, in Corvallis, and a research associate in the Department of Obstetrics and Gynecology at Oregon Health and Science University, in Portland, when this research was conducted
| | - Jeff Luck
- Jeff Luck is an associate professor in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University
| | - Jangho Yoon
- Jangho Yoon is an assistant professor of health policy in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University
| | - Stephanie Bernell
- Stephanie Bernell is an associate professor of health policy in the School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University
| | - Jonathan M. Snowden
- Jonathan M. Snowden is an assistant professor in the Department of Obstetrics and Gynecology at Oregon Health and Science University and at the Oregon Health and Science University/Portland State University School of Public Health
| |
Collapse
|