PD28-06 EFFECTS OF HOSPITAL COMPETITION ON RACIAL ETHNIC DISPARITY IN PROSTATE CANCER CARE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2018PD28-06 EFFECTS OF HOSPITAL COMPETITION ON RACIAL ETHNIC DISPARITY IN PROSTATE CANCER CARE Sumedha Chhatre, S Bruce Malkowicz, J Sanford Schwartz, and Ravishankar Jayadevappa Sumedha ChhatreSumedha Chhatre 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 Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1369AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To analyze the role of hospital competition in racial and ethnic disparity in quality of care and outcomes among prostate cancer patients. METHODS Population-based cohort study of Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 1995- 2013, linked with AMA and AHA data. Eligible patients were men 66 years or older with localized or advanced prostate cancer at diagnosis. The Hirschman-Herfindahl index (HHI) was computed for all serving hospitals. For each hospital we will calculate the number of competitors (number of hospitals situated within the predicted radius) and HHI. We considered pre-diagnosis, treatment, follow-up and terminal phases of care. Process of care measures were complications, ER admissions, readmissions, and treatment. Outcomes were overall and disease specific survival and cost. Propensity score and instrumental variable approaches were used to minimize biases. We used Cox regression for survival, log-link GLM models for cost, and Poisson (zero inflated) models for count data. Multilevel model was used to study the contribution of hospital competition to racial and ethnic disparity in outcomes. RESULTS In our cohort of 668,510 prostate cancer patients, 73.7% were white, 12.7% African American, 6.6% Hispanic and 4.6% Asian. African American patients were more likely to have lower income and higher comorbidity compared to whites. They were also less likely to be admitted to high competition hospitals, compared to whites. After adjusting for socio-demographic and clinical covariates, we observed that African American patients receiving care at low competitive hospitals were more likely to have complications (odds ratio (OR) = 1.39, 95%confidence interval (CI) = 1.13, 1.62) compared to white patients. On the other hand, African American patients receiving care in high competitive hospital were less likely to have complications (OR = 0.81, CI = 0.69, 0.95), and had lower hazard of long-term mortality (Hazard ratio (HR) = 0.89, CI = 0.78, 0.93) compared to white patients. Hospital competition was associated with improved quality of care and outcomes, and contributed to the racial and ethnic disparity. CONCLUSIONS This novel study showed that higher competition hospitals have positive implications for outcomes among patients with prostate cancer. Additional research is needed to identify the mechanism through which hospital competition affects prostate cancer care outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e564-e565 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sumedha Chhatre More articles by this author S Bruce Malkowicz More articles by this author J Sanford Schwartz More articles by this author Ravishankar Jayadevappa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...