Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.
Rutgers School of Public Health, Piscataway, NJ.
JCO Oncol Pract. 2021 May;17(5):e637-e644. doi: 10.1200/OP.20.01089.
Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation.
We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation.
Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer-accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation ( > .05).
The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.
黑种人女性承受着过多的合并症和乳腺癌负担。协调多种健康状况的护理可能会导致不良后果，而当护理在不同的医疗体系中进行时，这种情况会更加复杂，即护理碎片化。我们研究了初级保健和乳腺癌护理的实践设置类型，以评估护理碎片化程度。
我们分析了新泽西州 228 名患有乳腺癌且患有糖尿病和/或高血压的黑人女性的前瞻性队列数据。在乳腺癌诊断后，我们通过病历摘录，检查了首次初级保健就诊和原发性乳房手术的实践设置类型，并确定护理是在同一医疗体系内还是外进行。我们使用多变量逻辑回归来探讨与护理碎片化相关的社会人口学和临床因素。
使用了不同的初级保健设置：医疗集团（32.0%）、医疗系统（29.4%）、独立实践（23.7%）、合格的联邦健康中心（8.3%）和独立医院（6.1%）。手术护理主要发生在医疗系统中（79.8%），大多数医院都获得了癌症委员会认证。78.5%的黑人女性经历了护理碎片化，个体因素（年龄、医疗保险、癌症分期和合并症数量）与护理碎片化无关（>.05）。
大多数患有合并症的黑人乳腺癌幸存者在不同的医疗体系中接受初级保健和手术护理，这说明了护理碎片化的存在。需要制定跨医疗体系和实践设置的护理协调和医疗保健提供策略，以实现健康公平。
