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 journalArticlepeer-review

16 Scopus citations

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)1002-1011
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number5
DOIs
StatePublished - May 1 2016

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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