Preoperative experience for public hospital patients with gynecologic cancer: Do structural barriers widen the gap?

BACKGROUND Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer. METHODS A retrospec...

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Veröffentlicht in:	Cancer Jg. 122; H. 6; S. 859 - 867
Hauptverfasser:	Frey, Melissa K., Moss, Haley A., Musa, Fernanda, Rolnitzky, Linda, David‐West, Gizelka, Chern, Jing‐Yi, Boyd, Leslie R., Curtin, John P.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 15.03.2016
Schlagworte:	Adult Aged Female Genital Neoplasms, Female - diagnosis Genital Neoplasms, Female - surgery gynecologic neoplasms gynecologic surgery health care disparities health care inequalities Healthcare Disparities Hospitals, Private Hospitals, Public Humans Insurance, Health Length of Stay Middle Aged Neoplasm Staging Preoperative Period public hospitals Retrospective Studies Time-to-Treatment gynecologic neoplasms gynecologic surgery health care disparities public hospitals health care inequalities
ISSN:	0008-543X, 1097-0142, 1097-0142
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Abstract	BACKGROUND Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer. METHODS A retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014. RESULTS Two hundred fifty‐seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001). CONCLUSIONS Patients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established. Cancer 2016;122:859–67. © 2016 American Cancer Society. Health care disparities are present during the preoperative window for women with gynecologic cancer. Patients at a public hospital are subject to a greater number of preoperative visits and have to wait longer for surgery than patients at a private hospital.
AbstractList	Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer.BACKGROUNDWidespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer.A retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014.METHODSA retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014.Two hundred fifty-seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001).RESULTSTwo hundred fifty-seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001).Patients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established.CONCLUSIONSPatients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established. Health care disparities are present during the preoperative window for women with gynecologic cancer. Patients at a public hospital are subject to a greater number of preoperative visits and have to wait longer for surgery than patients at a private hospital. BACKGROUND Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer. METHODS A retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014. RESULTS Two hundred fifty‐seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001). CONCLUSIONS Patients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established. Cancer 2016;122:859–67. © 2016 American Cancer Society. Health care disparities are present during the preoperative window for women with gynecologic cancer. Patients at a public hospital are subject to a greater number of preoperative visits and have to wait longer for surgery than patients at a private hospital. Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer. A retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014. Two hundred fifty-seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001). Patients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established.
Author	David‐West, Gizelka Rolnitzky, Linda Chern, Jing‐Yi Moss, Haley A. Boyd, Leslie R. Musa, Fernanda Frey, Melissa K. Curtin, John P.
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Cites_doi	10.1002/cncr.25490 10.1016/j.ygyno.2013.12.039 10.1200/JCO.2003.01.061 10.1016/j.ygyno.2013.12.017 10.1186/1472-6963-14-407 10.1002/cncr.22604 10.1097/AOG.0000000000000636 10.1016/j.ygyno.2006.08.010 10.1016/0021-9681(87)90171-8 10.1200/JCO.2013.51.3671 10.1080/00016340902971482 10.7453/gahmj.2013.052 10.3322/caac.21208 10.1016/j.ygyno.2009.12.033 10.1097/01.AOG.0000265207.27755.28
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Keywords	gynecologic neoplasms gynecologic surgery health care disparities public hospitals health care inequalities
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Notes	This study was presented as an oral presentation at the Society of Gynecologic Oncology Early Education Summit in December 2014 and was presented as a poster at the Society of Gynecologic Oncology Annual Meeting in March 2015. We acknowledge Claudia Plottel, MD (New York University Langone Medical Center, Clinical and Translational Science Institute, New York University School of Medicine) for her support and participation in this project. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
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Snippet	BACKGROUND Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine... Health care disparities are present during the preoperative window for women with gynecologic cancer. Patients at a public hospital are subject to a greater... Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether...
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SubjectTerms	Adult Aged Female Genital Neoplasms, Female - diagnosis Genital Neoplasms, Female - surgery gynecologic neoplasms gynecologic surgery health care disparities health care inequalities Healthcare Disparities Hospitals, Private Hospitals, Public Humans Insurance, Health Length of Stay Middle Aged Neoplasm Staging Preoperative Period public hospitals Retrospective Studies Time-to-Treatment
Title	Preoperative experience for public hospital patients with gynecologic cancer: Do structural barriers widen the gap?
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