TY - JOUR
T1 - Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care
T2 - Analysis of Surveillance, Epidemiology and End Results-Medicare Data
AU - Charlton, Mary E.
AU - Hrabe, Jennifer E.
AU - Wright, Kara B.
AU - Schlichting, Jennifer A.
AU - McDowell, Bradley D.
AU - Halfdanarson, Thorvardur R.
AU - Lin, Chi
AU - Stitzenberg, Karyn B.
AU - Cromwell, John W.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background: Evidence suggests that high-volume facilities achieve better rectal cancer outcomes. Methods: Logistic regression was used to evaluate association of facility type with treatment after adjusting for patient demographics, stage, and comorbidities. SEER-Medicare beneficiaries who were diagnosed with stage II/III rectal adenocarcinoma at age ≥66 years from 2005 to 2009 and had Parts A/B Medicare coverage for ≥1 year prediagnosis and postdiagnosis plus a claim for cancer-directed surgery were included. Institutions were classified according to National Cancer Institute (NCI) designation, presence of residency program, or medical school affiliation. Results: Two thousand three hundred subjects (average age = 75) met the criteria. Greater proportions of those treated at NCI-designated facilities received transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI)-pelvis (62.1 vs. 29.9 %), neoadjuvant chemotherapy (63.9 vs. 41.8 %), and neoadjuvant radiation (70.8 vs. 46.3 %), all p < 0.0001. On multivariate analysis, odds ratios (95 % confidence intervals) for receiving TRUS or MRI, neoadjuvant chemotherapy, or neoadjuvant radiation among beneficiaries treated at NCI-designated facilities were 3.51 (2.60–4.73), 2.32 (1.71–3.16), and 2.66 (1.93–3.67), respectively. Results by residency and medical school affiliation were similar in direction to NCI designation. Conclusions: Those treated at hospitals with an NCI designation, residency program, or medical school affiliation received more guideline-concordant care. Initiatives involving provider education and virtual tumor boards may improve care.
AB - Background: Evidence suggests that high-volume facilities achieve better rectal cancer outcomes. Methods: Logistic regression was used to evaluate association of facility type with treatment after adjusting for patient demographics, stage, and comorbidities. SEER-Medicare beneficiaries who were diagnosed with stage II/III rectal adenocarcinoma at age ≥66 years from 2005 to 2009 and had Parts A/B Medicare coverage for ≥1 year prediagnosis and postdiagnosis plus a claim for cancer-directed surgery were included. Institutions were classified according to National Cancer Institute (NCI) designation, presence of residency program, or medical school affiliation. Results: Two thousand three hundred subjects (average age = 75) met the criteria. Greater proportions of those treated at NCI-designated facilities received transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI)-pelvis (62.1 vs. 29.9 %), neoadjuvant chemotherapy (63.9 vs. 41.8 %), and neoadjuvant radiation (70.8 vs. 46.3 %), all p < 0.0001. On multivariate analysis, odds ratios (95 % confidence intervals) for receiving TRUS or MRI, neoadjuvant chemotherapy, or neoadjuvant radiation among beneficiaries treated at NCI-designated facilities were 3.51 (2.60–4.73), 2.32 (1.71–3.16), and 2.66 (1.93–3.67), respectively. Results by residency and medical school affiliation were similar in direction to NCI designation. Conclusions: Those treated at hospitals with an NCI designation, residency program, or medical school affiliation received more guideline-concordant care. Initiatives involving provider education and virtual tumor boards may improve care.
KW - Guideline-concordant care
KW - Medicare
KW - Rectal cancer
KW - Surveillance, Epidemiology, and End Results
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U2 - 10.1007/s11605-015-3046-2
DO - 10.1007/s11605-015-3046-2
M3 - Article
C2 - 26658793
AN - SCOPUS:84949510836
SN - 1091-255X
VL - 20
SP - 1002
EP - 1011
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 5
ER -