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Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer.

作者信息

Lima Henrique A, Woldesenbet Selamawit, Moazzam Zorays, Endo Yutaka, Munir Muhammad Musaab, Shaikh Chanza, Rueda Belisario Ortiz, Alaimo Laura, Resende Vivian, Pawlik Timothy M

机构信息

Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.

Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.

出版信息

Ann Surg Oncol. 2023 Nov;30(12):7217-7225. doi: 10.1245/s10434-023-14146-3. Epub 2023 Aug 21.


DOI:10.1245/s10434-023-14146-3
PMID:37605082
Abstract

BACKGROUND: Disparities in utilization of post-discharge care and overall expenditures may relate to site of care and race/ethnicity. We sought to define the impact of minority-serving hospitals (MSHs) on postoperative outcomes, discharge disposition, and overall expenditures associated with an episode of surgical care. METHODS: Patients who underwent resection for esophageal, colon, rectal, pancreatic, and liver cancer were identified from Medicare Standard Analytic Files (2013-2017). A MSH was defined as the top decile of facilities treating minority patients (Black and/or Hispanic). The impact of MSH on outcomes of interest was analyzed using multivariable logistic regression and generalized linear regression models. Textbook outcome (TO) was defined as no postoperative complications, no prolonged length of stay, and no 90-day mortality or readmission. RESULTS: Among 113,263 patients, only a small subset of patients underwent surgery at MSHs (n = 4404, 3.9%). While 52.3% of patients achieved TO, rates were lower at MSHs (MSH: 47.2% vs. non-MSH: 52.5%; p < 0.001). On multivariable analysis, receiving care at an MSH was associated with not achieving TO (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.76-0.87) and concomitantly higher odds of additional post-discharge care (OR 1.10, 95% CI 1.01-1.20). Patients treated at an MSH also had higher median post-discharge expenditures (MSH: $8400, interquartile range [IQR] $2300-$22,100 vs. non-MSH: $7000, IQR $2200-$17,900; p = 0.002). In fact, MSHs remained associated with a 11.05% (9.78-12.33%) increase in index expenditures and a 16.68% (11.44-22.17%) increase in post-discharge expenditures. CONCLUSIONS: Patients undergoing surgery at a MSH were less likely to achieve a TO. Additionally, MSH status was associated with a higher likelihood of requiring post-discharge care and higher expenditures.

摘要

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引用本文的文献

[1]
Impact of Neighborhood Socioeconomic Trajectories on Gastrointestinal Cancer Care: A SEER-Medicare Analysis.

Ann Surg Oncol. 2025-7-8

[2]
Ongoing Failure to Deliver Guideline-Concordant Care for Patients with Pancreatic Cancer.

Cancers (Basel). 2025-1-7

[3]
Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021.

Health Serv Res. 2025-4

[4]
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Ann Surg Oncol. 2024-7

[5]
The Impact of Digital Inequities on Esophageal Cancer Disparities in the US.

Cancers (Basel). 2023-11-22

本文引用的文献

[1]
The impact of race/ethnicity and county-level upward economic mobility on textbook outcomes in hepatopancreatic surgery.

Surgery. 2023-5

[2]
ASO Author Reflections: Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving Versus Non-minority-Serving Hospitals.

Ann Surg Oncol. 2023-7

[3]
Hospital Volume and Textbook Outcomes in Minimally Invasive Hepatectomy for Hepatocellular Carcinoma.

J Gastrointest Surg. 2023-5

[4]
Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing.

J Gen Intern Med. 2023-2

[5]
Disparities in NCCN Guideline Compliant Care for Resectable Cholangiocarcinoma at Minority-Serving Versus Non-Minority-Serving Hospitals.

Ann Surg Oncol. 2021-12

[6]
Uptake of Breast Cancer Clinical Trials at Minority Serving Cancer Centers.

Ann Surg Oncol. 2021-9

[7]
Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals.

J Gastrointest Surg. 2021-7

[8]
Assessing post-discharge costs of hepatopancreatic surgery: an evaluation of Medicare expenditure.

Surgery. 2020-4-3

[9]
Novel Machine Learning Approach to Identify Preoperative Risk Factors Associated With Super-Utilization of Medicare Expenditure Following Surgery.

JAMA Surg. 2019-11-1

[10]
Characterizing and Assessing the Impact of Surgery on Healthcare Spending Among Medicare Enrolled Preoperative Super-utilizers.

Ann Surg. 2019-9

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