Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data

Mary E. Charlton, Jennifer E. Hrabe, Kara B. Wright, Jennifer A. Schlichting, Bradley D. McDowell, Thorvardur R. Halfdanarson, Chi Lin, Karyn B. Stitzenberg, John W. Cromwell

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Dec 9 2015

Fingerprint

National Cancer Institute (U.S.)
Rectal Neoplasms
Medicare
Epidemiology
Guidelines
Internship and Residency
Medical Schools
Medicare Part B
Magnetic Resonance Imaging
Radiation
Drug Therapy
Pelvis
Comorbidity
Neoplasms
Adenocarcinoma
Multivariate Analysis
Logistic Models
Odds Ratio
Demography
Confidence Intervals

Keywords

  • Guideline-concordant care
  • Medicare
  • Rectal cancer
  • Surveillance, Epidemiology, and End Results

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care : Analysis of Surveillance, Epidemiology and End Results-Medicare Data. / Charlton, Mary E.; Hrabe, Jennifer E.; Wright, Kara B.; Schlichting, Jennifer A.; McDowell, Bradley D.; Halfdanarson, Thorvardur R.; Lin, Chi; Stitzenberg, Karyn B.; Cromwell, John W.

In: Journal of Gastrointestinal Surgery, 09.12.2015, p. 1-10.

Research output: Contribution to journalArticle

Charlton, Mary E. ; Hrabe, Jennifer E. ; Wright, Kara B. ; Schlichting, Jennifer A. ; McDowell, Bradley D. ; Halfdanarson, Thorvardur R. ; Lin, Chi ; Stitzenberg, Karyn B. ; Cromwell, John W. / Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care : Analysis of Surveillance, Epidemiology and End Results-Medicare Data. In: Journal of Gastrointestinal Surgery. 2015 ; pp. 1-10.
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abstract = "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.",
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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.

PY - 2015/12/9

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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.

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KW - Medicare

KW - Rectal cancer

KW - Surveillance, Epidemiology, and End Results

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