Disparities in Colorectal Cancer Treatment Delay Within Appalachia--The Role of For-Profit Hospitals.
Disparities in Colorectal Cancer Treatment Delay Within Appalachia--The Role of For-Profit Hospitals.
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阿巴拉契亚地区结直肠癌治疗延迟的差异——营利性医院的作用。
DOI：
10.1111/jrh.12122
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Fleming,StevenT
中科院分区：
文献类型：
--
作者：
Seiber,EricE;Camacho,Fabian;Zeeshan,MuhammadFazal;Kern,TeresaT;Fleming,StevenT
由于阿巴拉契亚地区的独特性，该地区居民的总体癌症负担高于美国其他地区。治疗延迟在阿巴拉契亚地区差异很大，肯塔基州的结直肠癌患者的中位治疗延迟为5天，而宾夕法尼亚州、俄亥俄州的患者为9天，这项研究使用统计分解技术确定了这种治疗延迟差异的来源。方法这项研究使用了2006年至2008年阿巴拉契亚山脉癌症登记和医疗保险索赔数据肯塔基州、宾夕法尼亚州、俄亥俄州和北卡罗来纳州的县，以估计治疗延迟的两部分模型。一个瓦哈卡分解的2部分模型揭示了肯塔基州县和其余3个state.ResultsThe瓦哈卡分解的差异延迟的个人决定因素的贡献显示，较高的比例在营利性设施治疗的患者在肯塔基州证明了观察到的差距的关键因素。在肯塔基州，22.3%的患者在营利性机构开始治疗，而其他州的这一比例为1.4%。在营利性设施开始治疗的患者解释了79%的观察到的差异，立即治疗（<2天后诊断）和72%的肯塔基州的优势，在对数天treatment.ConclusionsThe独特的作用，营利性设施导致减少治疗延误的结直肠癌患者在肯塔基州。然而，营利性医院更快速的治疗是否能为结直肠癌患者带来更好的健康结果仍是未知数。
BackgroundAppalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined.ObjectiveThis study identified the source of this disparity in treatment delay using statistical decomposition techniques.MethodologyThis study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2‐part model of treatment delay. An Oaxaca Decomposition of the 2‐part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states.ResultsThe Oaxaca Decomposition revealed that the higher percentage of patients treated at for‐profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for‐profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for‐profit facilities explained 79% of the observed difference in immediate treatment (<2 days after diagnosis) and 72% of Kentucky's advantage in log days to treatment.ConclusionsThe unique role of for‐profit facilities led to reduced treatment delay for colorectal cancer patients in Kentucky. However, it remains unknown whether for‐profit hospitals’ more rapid treatment converts to better health outcomes for colorectal cancer patients.