The Value of Continuity between Primary Care and Surgical Care in Colon Cancer

Abstract

BackgroundImproving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs.MethodsUsing Surveillance, Epidemiology, and End Results Program Registry (SEER)-Medicare data, we performed a retrospective cohort study of stage I-III colon cancer patients diagnosed between 2000 and 2009. There were 23,305 stage I-III colon cancer patients who received primary care in the year prior to diagnosis and underwent operative care for colon cancer. Patients were assigned to the hospital where they had their surgery and to their primary care provider’s main hospital, and then classified according to whether these two hospitals were same or different. Outcomes examined were hazards for all-cause mortality, subhazard for colon cancer specific mortality, and generalized linear estimate for costs at 12 months, from propensity score matched models.ResultsFifty-two percent of stage I-III colon patients received primary care and surgical care from the same hospital. Primary care and surgical care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality, but was associated with lower inpatient, outpatient, and total costs of care. Total cost difference was $8,836 (95% CI $2,746–$14,577), a 20% reduction in total median cost of care at 12 months.ConclusionsReceiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital.

Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI

“…Since PCPs do not order MRIs, it is not immediately clear why a physician network with more PCPs would have a slower adoption of MRI. A previous study has shown an association of the co‐localization of surgical care and PCPs at the same hospital with significantly lower costs of care in colon cancer, suggesting that PCP peer relationships and placement in care structures may impact resource utilization in cancer care . However, evidence on the relationship between PCP concentration and spending is mixed.…”

Disparities in Utilization of Medical Specialists for Colonoscopy

“…A ZIP code-level variable was included instead, and it was shown to be a confounder and improved the model fit, a method that previous cancer studies have done. 45,46 Despite these limitations, this study is innovative because we used a population-based data source (i.e., generalizable across the entire state) of adults who received a colonoscopy and had the power to detect subgroup differences across race/ethnicity, insurance status, and patient county of residence.…”

Outcomes after Rehospitalization at the Same Hospital or a Different Hospital Following Critical Illness

“…Prior studies have shown benefits related to continuity of care with improvements in survival and decreases in rehospitalization and health care resource use (12)(13)(14)(15)(16)(17)(18)(19)(20). These studies have primarily demonstrated the benefits of continuity of care throughout outpatient medical visits (18,19), after hospitalization (defined as being seen by a familiar physician after hospital discharge or providing outpatient physicians with information about the hospitalization) (14)(15)(16)(17), and having continuity between surgical and primary care providers (20). Our study extends these findings, focusing on a very high-risk population with high mortality during rehospitalization.…”

“…Discontinuity of care has been shown to be common in both complex surgical and nonsurgical patients (11)(12)(13). Continuity of care (defined in various ways) is associated with improvements in survival as well as with decreased rates of rehospitalization, acute care use, and costs (12)(13)(14)(15)(16)(17)(18)(19)(20). Critically ill patients, particularly those receiving mechanical ventilation, are a group of medically complex patients at high risk for rehospitalization and thus represent an important population in which to determine whether a lack of continuity of care adversely affects outcomes of rehospitalization.…”