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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2023

21-08-2023 | Care | Gastrointestinal Oncology

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

Authors: Henrique A. Lima, MD, Selamawit Woldesenbet, PhD, Zorays Moazzam, MD, Yutaka Endo, MD, PhD, Muhammad Musaab Munir, MD, Chanza Shaikh, MD, Belisario Ortiz Rueda, MD, Laura Alaimo, MD, Vivian Resende, MD, PhD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 12/2023

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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.
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Literature
1.
Institute of Medicine (US) Committee on understanding and eliminating racial and ethnic disparities in health care, Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.
2.
Virnig BA, Baxter NN, Habermann EB, Feldman RD, Bradley CJ. A matter of race: early-versus late-stage cancer diagnosis. Health Aff (Millwood). 2009;28(1):160–8.CrossRefPubMedPubMedCentral
3.
Haider AH, Scott VK, Rehman KA, et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg. 2013;216(3):482-92.e12.CrossRefPubMedPubMedCentral
4.
Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.CrossRefPubMed
5.
Torain MJ, Maragh-Bass AC, Dankwa-Mullen I, et al. Surgical disparities: a comprehensive review and new conceptual framework. J Am Coll Surg. 2016;223(2):408–18.CrossRefPubMed
6.
Haider AH, Schneider EB, Sriram N, et al. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. JAMA Surg. 2015;150(5):457–64.CrossRefPubMed
7.
Cole AP, Nguyen DD, Meirkhanov A, et al. Association of care at minority-serving vs non-minority-serving hospitals with use of palliative care among racial/ethnic minorities with metastatic cancer in the united states. JAMA Netw Open. 2019;2(2):e187633.CrossRefPubMedPubMedCentral
8.
Fletcher SA, Gild P, Cole AP, et al. The effect of treatment at minority-serving hospitals on outcomes for bladder cancer. Urol Oncol. 2018;36(5):238.e7-238.e17.CrossRefPubMed
9.
Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82.CrossRefPubMed
10.
11.
Tsilimigras DI, Dalmacy D, Hyer JM, Diaz A, Abbas A, Pawlik TM. Disparities in NCCN guideline compliant care for resectable cholangiocarcinoma at minority-serving versus non-minority-serving hospitals. Ann Surg Oncol. 2021;28(13):8162–71.CrossRefPubMed
12.
13.
Haider AH, Ong’uti S, Efron DT, et al. Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals. Arch Surg. 2012;147(1):63–70.CrossRefPubMed
14.
Faigle R, Ziai WC, Urrutia VC, Cooper LA, Gottesman RF. Racial differences in palliative care use after stroke in majority-white, minority-serving, and racially integrated U. S. Hospitals. Crit Care Med. 2017;45(12):2046–54.CrossRefPubMedPubMedCentral
15.
Hyer JM, Paredes AZ, Cerullo M, et al. Assessing post-discharge costs of hepatopancreatic surgery: an evaluation of medicare expenditure. Surgery. 2020;167(6):978–84.CrossRefPubMed
16.
17.
Moazzam Z, Alaimo L, Lima HA, Endo Y, Pawlik TM. The impact of race/ethnicity and county-level upward economic mobility on textbook outcomes in hepatopancreatic surgery. Surgery. 2023;173(5):1192–8.CrossRefPubMed
18.
Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700–15.CrossRefPubMed
19.
Hyer JM, Ejaz A, Diaz A, et al. Characterizing and assessing the impact of surgery on healthcare spending among medicare enrolled preoperative super-utilizers. Ann Surg. 2019;270(3):554–63.CrossRefPubMed
20.
21.
Himmelstein G, Ceasar JN, Himmelstein KE. Hospitals that serve many black patients have lower revenues and profits: structural racism in hospital financing. J Gen Intern Med. 2023;38(3):586–91.CrossRefPubMed
22.
Graham LA, Mull HJ, Wagner TH, et al. Comparison of a potential hospital quality metric with existing metrics for surgical quality-associated readmission. JAMA Netw Open. 2019;2(4):e191313.CrossRefPubMedPubMedCentral
23.
Kneuertz PJ, Pitt HA, Bilimoria KY, et al. Risk of morbidity and mortality following Hepato-Pancreato-biliary surgery. J Gastrointest Surg. 2012;16(9):1727–35.CrossRefPubMed
24.
Kolfschoten NE, Kievit J, Gooiker GA, et al. Focusing on desired outcomes of care after colon cancer resections; hospital variations in ‘textbook outcome.’ Eur J Surg Oncol. 2013;39(2):156–63.CrossRefPubMed
25.
Merath K, Chen Q, Bagante F, et al. A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. JAMA Surg. 2019;154(6):e190571.CrossRefPubMedPubMedCentral
26.
Kantor O, Chang C, Yao K, et al. Uptake of breast cancer clinical trials at minority serving cancer centers. Ann Surg Oncol. 2021;28(9):4995–5004.CrossRefPubMed
27.
Krimphove MJ, Fletcher SA, Cole AP, et al. Quality of care in the treatment of localized intermediate and high risk prostate cancer at minority serving hospitals. J Urol. 2019;201(4):735–41.CrossRefPubMed
28.
Lu PW, Scully RE, Fields AC, et al. Racial disparities in treatment for rectal cancer at minority-serving hospitals. J Gastrointest Surg. 2021;25(7):1847–56.CrossRefPubMed
29.
Gottlieb-Vedi E, Mattsson F, Lagergren P, Lagergren J. Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis. Eur J Surg Oncol. 2019;45(10):1839–46.CrossRefPubMed
30.
Zogg CK, Jiang W, Chaudhary MA, et al. Racial disparities in emergency general surgery: do differences in outcomes persist among universally insured military patients? J Trauma Acute Care Surg. 2016;80(5):764–75.CrossRefPubMed
31.
Merath K, Chen Q, Bagante F, et al. Textbook outcomes among medicare patients undergoing hepatopancreatic surgery. Ann Surg. 2020;271(6):1116–23.CrossRefPubMed
32.
Kaye DR, Luckenbaugh AN, Oerline M, et al. Understanding the costs associated with surgical care delivery in the medicare population. Ann Surg. 2020;271(1):23–8.CrossRefPubMed
33.
Nathan H, Atoria CL, Bach PB, et al. Hospital volume, complications, and cost of cancer surgery in the elderly. J Clin Oncol. 2015;33(1):107–14.CrossRefPubMed
34.
Sheetz KH, Ibrahim AM, Regenbogen SE, et al. Surgeon experience and medicare expenditures for laparoscopic compared to open colectomy. Ann Surg. 2018;268(6):1036–42.CrossRefPubMed
35.
Birkmeyer JD, Gust C, Baser O, et al. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res. 2010;45(6 Pt 1):1783–95.CrossRefPubMedPubMedCentral
36.
Shubeck SP, Thumma JR, Dimick JB, Nathan H. Hot spotting as a strategy to identify high-cost surgical populations. Ann Surg. 2019;269(3):453–8.CrossRefPubMed
37.
Donohue JM, Normand SL, Horvitz-Lennon M, Men A, Berndt ER, Huskamp HA. Regional variation in physician adoption of antipsychotics: impact on US medicare expenditures. J Ment Health Policy Econ. 2016;19(2):69–78.PubMedPubMedCentral
38.
Hyer JM, Ejaz A, Tsilimigras DI, Paredes AZ, Mehta R, Pawlik TM. Novel machine learning approach to identify preoperative risk factors associated with super-utilization of medicare expenditure following surgery. JAMA Surg. 2019;154(11):1014–21.CrossRefPubMedPubMedCentral
39.
Pradarelli JC, Scally CP, Nathan H, Thumma JR, Dimick JB. Hospital teaching status and medicare expenditures for complex surgery. Ann Surg. 2017;265(3):502–13.CrossRefPubMed
40.
Borza T, Oreline MK, Skolarus TA, et al. Association of the hospital readmissions reduction program with surgical readmissions. JAMA Surg. 2018;153(3):243–50.CrossRefPubMed
Metadata
Title
Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer
Authors
Henrique A. Lima, MD
Selamawit Woldesenbet, PhD
Zorays Moazzam, MD
Yutaka Endo, MD, PhD
Muhammad Musaab Munir, MD
Chanza Shaikh, MD
Belisario Ortiz Rueda, MD
Laura Alaimo, MD
Vivian Resende, MD, PhD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
Publication date
21-08-2023
Publisher
Springer International Publishing
Keyword
Care
Published in
Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14146-3

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