Cheng Ning, Farley Joel, Qian Jingjing, Zeng Peng, Chou Chiahung, Hansen Richard
Department of Biomedical Affair, Edward Via College of Osteopathic Medicine Auburn Campus, Auburn, Alabama, USA.
Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, Minnesota, USA.
J Psychosoc Oncol. 2022;40(2):184-202. doi: 10.1080/07347332.2020.1867692. Epub 2021 Jan 18.
The association of continuity of care (COC) among providers and mortality risk for breast cancer patients with comorbidities is not sufficiently studied.
A retrospective cohort study using the 2006-2014 Surveillance, Epidemiology and End Results (SEER)-Medicare data.
Newly diagnosed female breast cancer patients ( = 57,578) with comorbidities (hypertension, hyperlipidemia, and/or diabetes).
All-cause mortality was assessed annually for up to 5 years. COC was estimated using the Bice-Boxerman index, which included: 1) specialty COC capturing continuity of visits to the same provider type (Primary Care Physicians, Oncologists, and Other specialists) and 2) individual COC capturing continuous care to the same provider regardless of provider specialty. Cox proportional hazards models estimated the hazard ratio (HR) of all-cause mortality across quartile of the COC index.
Mortality was positively associated with advanced tumor stages and number of comorbidities ( < 0.05). Patients with high specialty COC (4th vs. 1st quartile, HR 1.34, 95%CI 1.29-1.40) had higher risks of mortality compared with those with low specialty COC. However, patients with high individual COC (4th vs. 1st quartile, HR 0.53, 95%CI 0.51-0.54) had lower risks of mortality compared to those with low individual COC.
Receiving care from fewer providers is associated with lower mortality and from fewer types of provider is associated with higher mortality. The results might be confounded by uncontrolled factors and provoke the need for alternative patient care models that recognize the balance between appropriate subspecialties and minimizing the fragmentation of care within and across subspecialties.
对合并症乳腺癌患者中医疗服务连续性（COC）与死亡风险之间的关联研究尚不充分。
一项回顾性队列研究，使用2006 - 2014年监测、流行病学和最终结果（SEER）-医疗保险数据。
新诊断的合并症（高血压、高脂血症和/或糖尿病）女性乳腺癌患者（n = 57578）。
对长达5年的全因死亡率进行年度评估。使用Bice-Boxerman指数评估COC，该指数包括：1）专科COC，反映对同一类型医疗服务提供者（初级保健医生、肿瘤学家和其他专科医生）就诊的连续性；2）个体COC，反映对同一医疗服务提供者的持续护理，无论其专科类型。Cox比例风险模型估计了COC指数四分位数范围内全因死亡率的风险比（HR）。
死亡率与肿瘤晚期和合并症数量呈正相关（P < 0.05）。与专科COC低的患者相比，专科COC高的患者（第4四分位数与第1四分位数相比，HR 1.34，95%CI 1.29 - 1.40）死亡风险更高。然而，与个体COC低的患者相比，个体COC高的患者（第4四分位数与第1四分位数相比，HR 0.53，95%CI 0.51 - 0.54）死亡风险更低。
接受医疗服务的提供者较少与较低的死亡率相关，而接受较少类型的提供者服务与较高的死亡率相关。结果可能受到未控制因素的混淆，这引发了对替代患者护理模式的需求，该模式应认识到适当亚专科之间的平衡以及尽量减少亚专科内部和之间护理的碎片化。
