Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, a Member of Catholic Healthcare West, Phoenix, AZ, USA.
Gynecol Oncol. 2011 Apr;121(1):83-6. doi: 10.1016/j.ygyno.2010.11.028. Epub 2011 Jan 5.
To investigate access to surgical care for endometrial cancer in Arizona.
The Arizona HealthQuery (AZHQ) data warehouse with claims information on over 7 million patients in Arizona was searched using the International Classification of Disease (ICD-9) codes and Current Procedural Terminology (CPT) codes for endometrial cancer surgery from 2005 to 2008. Coordinates were gathered for patients and hospital to determine the distance traveled, race, insurance and annual caseload per hospital/surgeon were collected. Distance traveled was local (< 50 miles) or distant (≥ 50 miles) and served as the primary independent variable. Secondary variables included age, race, insurance, surgeon annual volume, and hospital annual volume. Logistic regression for distance traveled was performed for insurance coverage, race, hospital volume, and surgeon volume and expressed as an odds ratio.
There were 1532 endometrial cancer surgeries performed at 67 hospitals by 242 surgeons in 15 counties. Most (61%) were performed by high-volume surgeons. Approximately 1 in 5 (19%) of patients traveled greater than 50 miles. Medicare insured patients were twice (OR=2.07, 95% CI=1.38-3.13) and Medicaid patients were three times (OR=3.41, 95% CI=1.89-6.15) as likely to travel over 50 miles. No significant difference was found between uninsured and privately insured patients (OR=0.87, 95% CI=0.45-1.68). Patients were more likely to travel to a high volume facility (OR 2.39, 95% CI=1.26-4.51). Hispanics (OR=2.72, 95% CI=1.72-4.32) and Native Americans (OR=8.60, 95% CI=3.43-21.52) were more likely to travel compared to Caucasians.
In Arizona significantly different patterns of care are seen for endometrial cancer surgery based upon insurance coverage, race, surgeon and hospital. Patients travel farther to a high-volume hospital and high-volume surgeon. Hispanics or Native Americans travel farther for care when compared with Caucasians. Patients on government funded insurance plans travel farther for care than patients covered by private insurance or those lacking insurance.
调查亚利桑那州子宫内膜癌手术治疗的可及性。
使用 2005 年至 2008 年国际疾病分类（ICD-9）和当前程序术语（CPT）代码，对亚利桑那州超过 700 万患者的亚利桑那州健康查询（AZHQ）数据库进行了搜索，以获取子宫内膜癌手术信息。为患者和医院收集坐标，以确定所走的距离，收集种族、保险和医院/外科医生每年的病例数。所走的距离分为本地（<50 英里）和远程（≥50 英里），作为主要的独立变量。次要变量包括年龄、种族、保险、外科医生年手术量和医院年手术量。对保险覆盖范围、种族、医院数量和外科医生数量进行了远程旅行的逻辑回归，并表示为优势比。
在 15 个县的 67 家医院，由 242 名外科医生进行了 1532 例子宫内膜癌手术。其中约 61%是由高容量外科医生完成的。大约有 1/5（19%）的患者的旅行距离超过 50 英里。医疗保险参保患者的可能性是两倍（OR=2.07，95%CI=1.38-3.13），医疗补助患者的可能性是三倍（OR=3.41，95%CI=1.89-6.15）。未发现未参保和私人参保患者之间有显著差异（OR=0.87，95%CI=0.45-1.68）。患者更有可能前往高容量医疗机构（OR 2.39，95%CI=1.26-4.51）。与白人相比，西班牙裔（OR=2.72，95%CI=1.72-4.32）和美国原住民（OR=8.60，95%CI=3.43-21.52）更有可能长途旅行。
在亚利桑那州，基于保险覆盖范围、种族、外科医生和医院，子宫内膜癌手术的治疗模式存在显著差异。患者前往高容量医院和高容量外科医生的距离更远。与白人相比，西班牙裔或美国原住民在接受治疗时的旅行距离更远。政府资助保险计划的患者的治疗旅行距离比私人保险或没有保险的患者更远。
