Ovarian Cancer Care for the Underserved: Are Surgical Patterns of Care Different in a Public Hospital Setting?
Ovarian Cancer Care for the Underserved: Are Surgical Patterns of Care Different in a Public Hospital Setting?
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DOI：
10.1002/cncr.25490
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发表时间：
2011-02-15
期刊：
影响因子：
6.2
通讯作者：
Curtin, John P.
中科院分区：
文献类型：
--
作者：
Boyd, Leslie R.;Novetsky, Akiva P.;Curtin, John P.
背景：纽约市（NYC）公立医院系统包括妇科癌症的亚专科护理，为无论保险状况的患者提供护理。作者试图确定纽约市公立医院系统中卵巢癌患者的手术模式。方法：从2001年至2006年纽约州卫生部全州规划与研究合作系统数据库中确定卵巢癌病例。来自纽约市医院的病例被分为两组：公立医院和纽约市其他医院。使用数据库确定与每个病例相关的外科医生，并根据病例量和亚专科培训的存在进行分层。结果：共发现12202例卵巢癌入院病例。其中，3639例涉及大手术，187例在公立医院进行。在公共队列中有更多的非裔美国人和亚裔患者（P < 0.001）。在公共队列中，主要保险人更有可能是医疗补助计划或自付者（P < 0.001）。紧急或紧急入院占公立医院所有入院人数的55%，而纽约市其他医院的入院人数为29% （P < .001）。与纽约市其他医院的患者相比，公立医院的患者更不可能由妇科肿瘤学家进行手术（57%对74%，P < 0.001），更不可能由大容量外科医生进行手术（21%对47%，P < 0.001）。结论：在公立医院接受治疗的卵巢癌患者较少有妇科肿瘤学家和大容量外科医生参与其护理。这是一个初步的发现，值得进一步调查。癌症2011;117:777 - 83。(C) 2010年美国癌症协会
BACKGROUND: The New York City (NYC) public hospital system includes subspecialty care for gynecologic cancers, providing care to patients regardless of insurance status. The authors sought to determine the surgical patterns of care for ovarian cancer patients in the NYC public hospital system. METHODS: Ovarian cancer cases were identified in the New York State Department of Health Statewide Planning and Research Cooperative System database for years 2001 to 2006. Cases from NYC hospitals were separated into 2 cohorts: public and other NYC hospitals. Surgeons associated with each case were identified using the database and were stratified by volume of cases and presence of subspecialty training. RESULTS: A total of 12,202 admissions for ovarian cancer were identified. Of these, 3639 involved major surgery, and 187 were performed at public hospitals. There were more African American and Asian patients in the public cohort (P < .001). The primary insurer was more likely to be Medicaid or a self-payer in the public cohort (P < 0.001). Urgent or emergent admissions comprised 55% of all admissions in public hospitals, compared with 29% of admissions in other NYC hospitals (P < .001). Patients in public hospitals were less likely to have their surgery performed by a gynecologic oncologist (57% vs 74%, P < .001) and less likely to have their surgery performed by a high-volume surgeon (21% vs 47%; P < .001) compared with patients in other NYC hospitals. CONCLUSIONS: Ovarian cancer patients treated in public hospitals are less likely to have gynecologic oncologists and high-volume surgeons involved in their care. This is a preliminary finding that warrants further investigation. Cancer 2011;117:777-83. (C) 2010 American Cancer Society