PD13-09 ASSOCIATION OF HOSPITAL COMPETITION AND EFFICIENCY WITH DISPARITY IN QUALITY OF PROSTATE CANCER CARE

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I (PD13)1 Sep 2021PD13-09 ASSOCIATION OF HOSPITAL COMPETITION AND EFFICIENCY WITH DISPARITY IN QUALITY OF PROSTATE CANCER CARE Ravishankar Jayadevappa, S. Bruce Malkowicz, J. Sanford Schwartz, and Sumedha Chhatre Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author , S. Bruce MalkowiczS. Bruce Malkowicz More articles by this author , J. Sanford SchwartzJ. Sanford Schwartz More articles by this author , and Sumedha ChhatreSumedha Chhatre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001989.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hospital competition and efficiency can affect disparity in quality and cost of prostate cancer care. We examined the association of hospital competition and efficiency with process of care (time to and type of treatment, and overuse) and outcomes (medial care use, complications, mortality and cost) in Medicare enrollees with prostate cancer. METHODS: Study of Surveillance, Epidemiological, and End Results-Medicare data from 1995- 2016, linked with American Medical Association and American Hospital Association data. Cohort was prostate cancer patients aged ≥ 66 years. The Hirschman-Herfindahl index (HHI) was computed for all serving hospitals based on number of competitors. Overuse Index was used to measure overuse during treatment and follow-up phase. We computed hospital technical efficiency using data envelopment analysis. Outcomes were overall and prostate cancer-specific survival, readmissions, ER visits, and cost. We used survival analysis, competing risk analysis, Poisson models, and GLM (log-link) models. Multilevel models were used to address clustering. Propensity score and instrumental variable approaches were used to minimize potential biases. RESULTS: Of 434,264 patients, 85% had localized and 15% had advanced disease. Age, race/ethnicity, comorbidity, socio-economic status, and treatment differed by high vs. low hospital competition. Hospitals in high competition area were more likely to perform surgery, and those in low competition area used radiation therapy. In localized disease group, low competition was associated with higher hazard of overall (HR=1.08, 95% CI=1.07 - 1.10) and prostate cancer-specific mortality (HR=1.13, 95% CI=1.09 - 1.17) and higher odds of ER visits. Similar results were observed for the advanced stage group. Association between hospital efficiency and mortality varied by racial and ethnic groups. Higher hospital efficiency was associated with lower mortality, and ER admissions. CONCLUSIONS: Higher hospital competition is associated with improved quality of care and lower cost in prostate cancer care. Increasing hospital efficiency may reduce some of the disparity in prostate cancer outcomes. Racial and ethnic differences must be considered while planning hospital efficiency models. Policies to redirect minority patients to higher efficiency hospitals may reduce racial and ethnic disparity in quality of care and outcomes. Source of Funding: Agency for Healthcare and Research Quality 1R01HS024106-01 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e212-e213 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravishankar Jayadevappa More articles by this author S. Bruce Malkowicz More articles by this author J. Sanford Schwartz More articles by this author Sumedha Chhatre More articles by this author Expand All Advertisement Loading ...