441 RACIAL VARIATION IN THE QUALITY OF CARE AMONG PATIENTS UNDERGOING CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 2011441 RACIAL VARIATION IN THE QUALITY OF CARE AMONG PATIENTS UNDERGOING CYSTECTOMY FOR BLADDER CANCER Daniel Barocas, Darryl Gray, Jay Fowke, Sam Chang, Michael Cookson, Joseph A. Smith, and David Penson Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , Darryl GrayDarryl Gray Rockville, MD More articles by this author , Jay FowkeJay Fowke Nashville, TN More articles by this author , Sam ChangSam Chang Nashville, TN More articles by this author , Michael CooksonMichael Cookson Nashville, TN More articles by this author , Joseph A. SmithJoseph A. Smith Nashville, TN More articles by this author , and David PensonDavid Penson Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.532AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BC). Quality indicators in patients undergoing surgery for BC include use of high-volume surgeons (HVSs) and hospitals (HVHs), receipt of pelvic lymphadenectomy (PLND) and undergoing radical cystectomy (RC) instead of partial cystectomy (PC) when clinically indicated. We compared these quality indicators in African-American (AA) and Caucasian patients with BC. METHODS We used public-access versions of the Healthcare Cost and Utilization Project's non-federal State Inpatient Databases, selecting NY, FL, and MD (1996–2007), because they consistently included race, surgeon and hospital identifiers. PC and RC cases among BC patients were identified by ICD-9-CM codes. Surgeon and hospital volume were defined as the number of RCs+PCs performed within a calendar year, with quartiles defined by state and year (highest quartile was considered high-volume.) Quality indicators were compared across racial groups using mixed-effects logistic regression, adjusting for age, Elixhauser comorbidity sum, insurance, and year of surgery, with random effects for state. Use of RC vs. PC was compared in all patients; use of other quality indicators was compared in the sub-group who underwent RC. RESULTS There were 16,631 cases, 13,917 (83.7%) RCs and 2,713 (16.3%) PCs. The cohort was 87.0% Caucasian, 5.3% African-American and 7.8% Other. Compared with Whites, AA patients were younger (65.3 SD [11.6] vs. 69.4 [10.3] years, p<0.001), were more commonly on Medicaid (13.0% vs. 2.4%, p<0.001), and had higher comorbidity counts (26.4% vs. 21.9% with 3 or more comorbidities, p=0.014). AA patients had markedly lower utilization of high-quality surgical services for BC (table.) Surgical Quality of Care Indicators by Racial Group Quality Indicator Yes No Univariate Multivariate⁎⁎ N(%) N(%) Chi-square p value OR 95% CI p value Radical Cystectomy(vs. Partial) White 12,154(84.1) 2,307(15.9) 1.0(referent) African-American 714(81.4) 163(18.6) 0.039 0.71 0.59–0.85 <0.001 Pelvic Lymphadenectomy⁎ White 6,809(56.0) 5,345(44.0) 1.0(referent) African-American 302(42.3) 412(57.7) <0.001 0.55 0.47–0.65 <0.001 Use of High-Volume Surgeon⁎ White 6,991(59.9) 4,684(40.1) 1.0(referent) African-American 335(48.7) 353(51.3) <0.001 0.61 0.52–0.71 <0.001 Use of High-Volume Hospital⁎ White 8,453(69.6) 3,701(30.5) 1.0(referent) African-American 420(58.8) 294(41.2) <0.001 0.61 0.52–0.72 <0.001 ⁎ Pertains to patients who underwent radical cystectomy; ⁎⁎ Mixed-effects logistic regression models, adjusting for age, Elixhauser comorbidity sum, insurance, and year of surgery, with random effects for state. CONCLUSIONS As indicators of healthcare quality among patients undergoing surgery for bladder cancer, utilization of radical compared to partial cystectomy, and use of PLND, HVSs and HVHs among patients undergoing radical cystectomy, varied by race in our sample. Assuming that these findings do not reflect differences in surgical indications among study patients, they may identify a quality gap in the surgical care of bladder cancer patients, which could in turn influence important healthcare outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e179-e180 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Barocas Nashville, TN More articles by this author Darryl Gray Rockville, MD More articles by this author Jay Fowke Nashville, TN More articles by this author Sam Chang Nashville, TN More articles by this author Michael Cookson Nashville, TN More articles by this author Joseph A. Smith Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...