The Value of Continuity between Primary Care and Surgical Care in Colon Cancer.
The Value of Continuity between Primary Care and Surgical Care in Colon Cancer.
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DOI：
10.1371/journal.pone.0155789
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Pollack CE
中科院分区：
文献类型：
--
作者：
Hussain T;Chang HY;Luu NP;Pollack CE
改善初级保健和癌症护理之间的连续性对于改善癌症预后和控制癌症成本至关重要。作为连续性的一个维度，我们调查了患者如何定期从同一家医院接受结肠癌的初级护理和手术护理，以及这是否会影响死亡率和成本。使用监测、流行病学和最终结果项目登记（SEER）-医疗保险数据，我们对2000年至2009年诊断的I-III期结肠癌患者进行了回顾性队列研究。有23，305名I-III期结肠癌患者在诊断前一年接受了初级护理，并接受了结肠癌手术护理。病人被分配到他们做手术的医院和他们的初级保健提供者的主要医院，然后根据这两家医院是相同还是不同进行分类。研究的结果是全因死亡率的危险，结肠癌特异性死亡率的亚危险，以及12个月时的费用的广义线性估计，来自倾向评分匹配模型。52%的I-III期结肠患者在同一家医院接受初级护理和手术护理。来自同一家医院的初级保健和手术治疗与降低全因或结肠癌特异性死亡率无关，但与降低住院、门诊和总护理费用相关。总成本差异为8，836美元（95% CI 2，746 - 14，577美元），12个月时的总中位护理成本降低了20%。与不同医院相比，在同一家医院接受初级保健和手术治疗与I-III期结肠癌患者的低成本相关，但仍具有相似的生存率。尽管如此，鼓励进一步整合初级保健和癌症护理以改善结果并降低成本的医疗保健政策需要解决在一家以上医院接受医疗保健的患者比例很大的问题。
Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs. Using Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider’s main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models. Fifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746–$14,577), a 20% reduction in total median cost of care at 12 months. Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital.