R. L. Hoffman1, K. T. Collier1, J. Tong1, S. Dasani1, G. C. Karakousis1, R. R. Kelz1 1University Of Pennsylvania,Philadelphia, PA, USA
Introduction: The healthcare crisis in the United States is ongoing. Great debate exists over the best approach to control costs and improve the quality of care provided to patients. The goal of this study was to examine the association between patient characteristics and the ability to receive optimal patient care from a public health perspective using colorectal cancer as a model.
Methods: A retrospective cohort study was performed using inpatient claims from California and New York (2008-2011) for all patients admitted with a new diagnosis of colon (CC) or rectal cancer (RC). From a public health perspective, optimal care was defined as a patient who was not admitted through the emergency department and underwent surgery within the first 24 hours of admission for a known nonmetastatic CC or RC. Univariate and multivariate regression was used to compare patients who received optimal care to those who did not with planned subset analysis in the surgical cohort by malignancy.
Results: A total of 38,568 patients, 30,580 (79.3%) with CC and 7,988 (20.7%) with RC were identified. There were 5,626 patients with metastatic disease. There were 19,268 (50.0%) patients who had surgery within first 24hrs and 29,868 (77.4%) were not admitted via the emergency department. Optimal care was received by 14,109 (36.9%) patients; 8,807 (29.0%) of CC and 5,302 (67.6%) of RC patients (p<0.001). Patients with commercial insurance had the highest rates of optimal care (42.2%) compared to Medicare (34.6%), Medicaid (30.0%) and self-pay (21.3%; p<0.001). In multivariate analysis race, sex, number of comorbidities and insurance status were significantly associated with the likelihood of receiving optimal cancer care (see table).
Conclusion: Despite numerous public health campaigns to increase awareness of colorectal cancer and available screening modalities, less than 40% of patients receive optimal care leading up to definitive treatment. Future efforts to increase the proportion of patients receiving optimal care will depend on significant buy-in from patients, the physicians they encounter prior to surgery and policies that make compliance with screening recommendations more feasible.
