Navarro Stephanie, Le Jessica, Tsui Jennifer, Barzi Afsaneh, Stern Mariana C, Pickering Trevor, Farias Albert J
Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA.
Keck School of Medicine of USC, Los Angeles, CA.
Med Care. 2025 Mar 1;63(3):256-265. doi: 10.1097/MLR.0000000000002112. Epub 2024 Dec 27.
After cancer diagnosis, non-White patients and those with multimorbidity use less primary care and more acute care than non-Hispanic White (NHW) patients and those lacking comorbidities. Yet, positive patient experiences with physician communication (PC) are associated with more appropriate health care use. In a multimorbid cohort, we measured associations between PC experience, race and ethnicity, and health care use following colorectal cancer (CRC) diagnosis.
We identified 2606 participants using Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Health Care Providers and Systems (CAHPS) data who were diagnosed with CRC from 2001 to 2017 with pre-existing chronic conditions. Self-reported PC experiences were derived from Medicare CAHPS surveys. Chronic condition care, emergency department, and hospital use following CRC diagnosis were identified from Medicare claims. Simple survey-weighted multivariable logistic regression stratified by experiences with care analyzed associations between race and ethnicity and health care use.
Among patients reporting excellent PC experience, non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) patients were more likely to use sufficient chronic condition care than NHW patients (NHB: OR=1.48, 99.38% CI=1.38-1.58; Hispanic: OR=1.34, 99.38% CI=1.26-1.42; NHA: OR=2.31, 99.38% CI=2.12-2.51). NHB and NHA patients were less likely than NHW patients to visit the emergency department when reporting excellent PC experience (NHB: OR=0.66, 99.38% CI=0.63-0.69; NHA: OR=0.67, 99.38% CI=0.64-0.71). Among patients reporting excellent PC, NHB, Hispanic, and NHA patients were less likely than NHW patients to be hospitalized (NHB: OR=0.93, 99.38% CI=0.87-0.99; Hispanic: OR=0.93, 99.38% CI=0.87-0.99; NHA: OR=0.20, 99.38% CI=0.19-0.22).
Improving patient experiences with PC, particularly among older racial and ethnic minority cancer survivors with chronic conditions, may help reduce disparities in adverse healthcare use following CRC diagnosis.
癌症确诊后，非白人患者以及患有多种疾病的患者比非西班牙裔白人（NHW）患者以及无合并症的患者使用的初级保健服务更少，而更多地使用急症护理服务。然而，患者对医患沟通（PC）的积极体验与更恰当的医疗保健使用相关。在一个患有多种疾病的队列中，我们测量了PC体验、种族和族裔与结直肠癌（CRC）诊断后的医疗保健使用之间的关联。
我们使用监测、流行病学和最终结果（SEER）-医疗保健提供者和系统消费者评估（CAHPS）数据，确定了2606名在2001年至2017年期间被诊断患有CRC且已有慢性病的参与者。自我报告的PC体验来自医疗保险CAHPS调查。CRC诊断后的慢性病护理、急诊科和住院使用情况从医疗保险理赔记录中确定。通过护理体验进行分层的简单调查加权多变量逻辑回归分析了种族和族裔与医疗保健使用之间的关联。
在报告PC体验良好的患者中，非西班牙裔黑人（NHB）、西班牙裔和非西班牙裔亚洲（NHA）患者比NHW患者更有可能充分使用慢性病护理（NHB：比值比[OR]=1.48，99.38%置信区间[CI]=1.38 - 1.58；西班牙裔：OR=1.34，99.38% CI=1.26 - 1.42；NHA：OR=2.31，99.38% CI=2.12 - 2.51）。当报告PC体验良好时，NHB和NHA患者比NHW患者去急诊科就诊的可能性更小（NHB：OR=0.66，99.38% CI=0.63 - 0.69；NHA：OR=0.67，99.38% CI=0.64 - 0.71）。在报告PC体验良好的患者中，NHB、西班牙裔和NHA患者比NHW患者住院的可能性更小（NHB：OR=0.93，99.38% CI=0.87 - 0.99；西班牙裔：OR=0.93，99.38% CI=0.87 - 0.99；NHA：OR=0.20，99.38% CI=0.19 - 0.22）。
改善患者对PC的体验，尤其是在患有慢性病的老年种族和族裔少数癌症幸存者中，可能有助于减少CRC诊断后不良医疗保健使用方面的差异。
