为高比例医疗补助计划患者提供服务的医院，在结肠癌护理的循证指南方面表现良好吗？
Do hospitals that serve a high percentage of Medicaid patients perform well on evidence-based guidelines for colon cancer care?
作者信息
Rhoads Kim F, Ngo Justine V, Ma Yifei, Huang Lyen, Welton Mark L, Dudley R Adams
出版信息
J Health Care Poor Underserved. 2013 Aug;24(3):1180-93. doi: 10.1353/hpu.2013.0122.
BACKGROUND
Previous work suggests hospitals serving high percentages of patients with Medicaid are associated with worse colon cancer survival. It is unclear if practice patterns in these settings explain differential outcomes.
HYPOTHESIS
High Medicaid hospitals (HMH) have lower compliance with evidence-based care processes (examining 12 or more lymph nodes (LN) during surgical staging and providing appropriate chemo-therapy).
METHODS
Retrospective analysis of stage I-III colon cancers from California Cancer Registry (1996-2006) linked to discharge abstracts and hospital profiles predicted hospital compliance with guidelines and trends in compliance over time.
RESULTS
Cases (N=60,000) in 439 hospitals analyzed. High Medicaid hospital settings had lower odds of compliance with the 12 LN exam (OR(HMH)0.91, CI(HMH)[0.85, 0.98]) and with the delivery of appropriate chemotherapy (OR(HMH)0.76, CI(HMH)[0.67, 0.86]).
CONCLUSIONS
High Medicaid hospital status is associated with poor performance on evidence-based colon cancer care. Policies to improve the quality of colon cancer care should target these settings.
背景
先前的研究表明，为高比例医疗补助患者服务的医院与较差的结肠癌生存率相关。目前尚不清楚这些环境中的医疗实践模式是否能解释不同的结果。
假设
高医疗补助医院（HMH）对循证医疗流程的依从性较低（手术分期时检查12个或更多淋巴结（LN）并提供适当的化疗）。
方法
对加利福尼亚癌症登记处（1996 - 2006年）的I - III期结肠癌进行回顾性分析，该分析与出院摘要和医院概况相关联，以预测医院对指南的依从性以及随时间的依从性趋势。
结果
分析了439家医院的60000例病例。高医疗补助医院环境下，进行12个LN检查的依从几率较低（OR（HMH）0.91，CI（HMH）[0.85，0.98]），提供适当化疗的依从几率也较低（OR（HMH）0.76，CI（HMH）[0.67，0.86]）。
结论
高医疗补助医院状态与循证结肠癌护理的不佳表现相关。改善结肠癌护理质量的政策应针对这些环境。
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