Ortiz-Ortiz Karen J, Ríos-Motta Ruth, Marín-Centeno Heriberto, Cruz-Correa Marcia R, Ortiz Ana P
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA.
Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA.
Health Serv Res Manag Epidemiol. 2016 May 9;3:2333392816646670. doi: 10.1177/2333392816646670. eCollection 2016 Jan-Dec.
In this study, we examine factors associated with the use of the emergency room (ER) as an entry point into the health-care system to initiate a cancer diagnosis among Puerto Rico's Government Health Plan (GHP) patients and compare the 1-year survival of GHP patients that initiated cancer diagnosis in the emergency room (ER) presentation with those that initiated the diagnosis in a physician's office.
Data for patients with colorectal cancer (CRC) aged 50 to 64 years and diagnosed in 2012 were obtained from the Puerto Rico Central Cancer Registry and linked to the Puerto Rico Health Insurance Administration database (n = 190). Crude odds ratio, adjusted odds ratio, and their 95% confidence intervals were reported. We used the Kaplan-Meier method to generate survival curves. Multivariate Cox regression analysis was performed to evaluate the association between ER presentation and 1-year cause-specific survival.
We found that 37.37% of the study population had an ER presentation. Male patients had a higher occurrence of having an ER presentation (66.20%), while 76.06% of the patients with an ER presentation were diagnosed in late stage. Emergency room presentation was a highly predictive factor for cancer mortality in the year following the diagnosis. These patients had between 3.99 to 4.24 times higher mortality risk than non-ER presentation patients ( < .05).
Late presentation for CRC diagnosis through an ER visit is a significant concern that influences negatively on the patient's outcome. Efforts at increasing primary care visits and routine screening tests among GHP beneficiaries could improve survival.
在本研究中，我们调查了波多黎各政府健康计划（GHP）患者将急诊室（ER）作为进入医疗保健系统以启动癌症诊断的相关因素，并比较了在急诊室就诊时启动癌症诊断的GHP患者与在医生办公室启动诊断的患者的1年生存率。
从波多黎各中央癌症登记处获取2012年诊断的50至64岁结直肠癌（CRC）患者的数据，并与波多黎各健康保险管理数据库相关联（n = 190）。报告了粗比值比、调整后的比值比及其95%置信区间。我们使用Kaplan-Meier方法生成生存曲线。进行多变量Cox回归分析以评估急诊室就诊与1年病因特异性生存之间的关联。
我们发现37.37%的研究人群有急诊室就诊经历。男性患者急诊室就诊的发生率更高（66.20%），而76.06%的急诊室就诊患者被诊断为晚期。急诊室就诊是诊断后一年癌症死亡率的高度预测因素。这些患者的死亡风险比非急诊室就诊患者高3.99至4.24倍（P <.05）。
通过急诊室就诊进行CRC诊断的延迟就诊是一个重大问题，对患者的预后有负面影响。在GHP受益人中增加初级保健就诊和常规筛查测试的努力可能会提高生存率。
