Fragmentation in specialist care and stage III colon cancer.
Fragmentation in specialist care and stage III colon cancer.
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DOI：
10.1002/cncr.29474
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发表时间：
2015-09-15
期刊：
影响因子：
6.2
通讯作者：
Pollack CE
中科院分区：
文献类型：
--
作者：
Hussain T;Chang HY;Veenstra CM;Pollack CE
癌症患者经常在不同类型的专家和不同的护理环境之间转换。我们探讨了III期结肠癌患者在多家医院接受内科和外科肿瘤治疗的频率，以及这是否与死亡率和费用有关。这是一项回顾性SEER-Medicare队列研究，研究对象为9075名在2000年至2009年间诊断出的III期结肠癌患者，在诊断后一年内接受手术和内科肿瘤治疗。患者被分配到他们进行癌症手术的医院和他们的肿瘤医生的主要医院，然后根据这些医院是相同的还是不同的特征。结果包括全因死亡率、结肠癌特异性亚危险死亡率和12个月时的护理费用。37%的患者在不同的医院接受外科和内科肿瘤治疗。农村患者比城市患者更不可能在同一家医院接受肿瘤内科治疗（OR 0.62, 95%CI 0.43-0.90）。同一家医院的治疗与全因或结肠癌特异性死亡率的降低无关，但导致12个月的成本降低（节省了5493美元，95%可信区间为1799美元，9525美元），为中位数成本的8%。在同一家医院提供外科和肿瘤内科治疗的费用较低；然而，寻求通过整合复杂护理来改善结果和成本的改革将需要解决在一家以上医院接受护理的患者的很大比例问题。
Patients with cancer frequently transition between different types of specialists and across care settings. We explored how frequently the medical and surgical oncologic care of stage III colon cancer patients occurs across more than one hospital and whether this is associated with mortality and costs. This is a retrospective SEER-Medicare cohort study of 9,075 stage III colon cancer patients diagnosed between 2000 and 2009 receiving both surgical and medical oncologic care within one year of diagnosis. Patients were assigned to the hospital where they had their cancer surgery and to their oncologist's primary hospital, and then characterized according to whether these hospitals were same or different. Outcomes included all-cause mortality, subhazards for colon cancer specific mortality, and cost of care at 12 months. 37% of patients received their surgical and medical oncologic care from different hospitals. Rural patients were less likely than urban patients to receive medical oncologic care from the same hospital (OR 0.62, 95%CI 0.43-0.90). Care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality but resulted in lower costs at 12 months (dollars saved $5493, 95%CI $1799, $9525), 8% of median cost. Delivery of surgical and medical oncology care at the same hospital was associated with lower costs; however, reforms which seek to improve outcomes and cost through integrating complex care will need to address the significant proportion of patients receiving care across more than one hospital.