Abstract
BackgroundImproving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs.MethodsUsing Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider’s main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models.ResultsFifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746–$14,577), a 20% reduction in total median cost of care at 12 months.ConclusionsReceiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital.
Highlights
Improving care transitions and continuity between primary care and specialty care are a focus of health care reform and important for achieving high value cancer care—that is, care which achieves optimal patient outcomes while containing costs [1,2,3]
Continuity between Primary Care and Surgical Cancer Care submitted as a new application with all the appropriate paperwork
Health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital
Summary
Improving care transitions and continuity between primary care and specialty care are a focus of health care reform and important for achieving high value cancer care—that is, care which achieves optimal patient outcomes while containing costs [1,2,3]. One factor that may be associated with improved continuity between primary care and cancer care is whether these providers are part of the same hospital system. The association between patients receiving primary care and cancer care from physicians affiliated with the same hospital and mortality or costs has not been evaluated. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs.
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