Justin G Trogdon1,2, Yunkyung Chang3, Saray Shai4, Peter J Mucha5, Tzy-Mey Kuo2, Anne M Meyer2,6, Karyn B Stitzenberg2,7. 1. Department of Health Policy and Management, Gillings School of Global Public Health. 2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC. 3. Quintiles Inc., Durham, NC. 4. Department of Mathematics and Computer Science, Wesleyan University, Middletown, CT. 5. Department of Mathematics, Carolina Center for Interdisciplinary Applied Mathematics. 6. Department of Epidemiology, Gillings School of Global Public Health. 7. Department of Surgery, Division of Surgical Oncology and Endocrinology Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Abstract
OBJECTIVES: To estimate the association between provider and team experience and adherence to guidelines, survival, and utilization among colorectal cancer patients in North Carolina. SUBJECTS: The analysis cohort included 7295 patients diagnosed with incident stage II/III colorectal cancer between 2004 and 2013 who received surgery. METHODS: Primary outcomes included adherence to guidelines: consultation with a medical oncologist (stage III), receipt of adjuvant chemotherapy (stage III), and receipt of surveillance colonoscopy posttreatment. Secondary outcomes included 5-year overall survival, number of surveillance radiology studies, any unplanned hospitalization, and any emergency department visit. The primary predictors were measures of provider volume and patient sharing across surgeons and medical oncologists. Regression analyses adjusted for patient and provider characteristics. RESULTS: Patients whose surgeons shared >40% of their colorectal cancer patients in the previous year with a medical oncologist were (1) more likely to have had a consultation with a medical oncologist [marginal effect (ME)=13.3 percentage points, P-value<0.001], (2) less likely to receive a surveillance colonoscopy within 12 months (ME=3.5 percentage points, P-value=0.049), and (3) received more radiology studies (ME=0.254 studies, P-value=0.029). Patients whose surgeon and medical oncologist shared >20% of their colorectal cancer patients with each other in the previous year had a higher likelihood of receiving adjuvant chemotherapy (ME=11.5 percentage points, P-value<0.001) and surveillance colonoscopy within 12 months (ME=6.7 percentage points, P-value=0.030) and within 18 months (ME=6.2 percentage points, P-value=0.054). CONCLUSIONS: Our study shows that team experience is associated with patients' quality of care, survival, and utilization.
OBJECTIVES: To estimate the association between provider and team experience and adherence to guidelines, survival, and utilization among colorectal cancerpatients in North Carolina. SUBJECTS: The analysis cohort included 7295 patients diagnosed with incident stage II/III colorectal cancer between 2004 and 2013 who received surgery. METHODS: Primary outcomes included adherence to guidelines: consultation with a medical oncologist (stage III), receipt of adjuvant chemotherapy (stage III), and receipt of surveillance colonoscopy posttreatment. Secondary outcomes included 5-year overall survival, number of surveillance radiology studies, any unplanned hospitalization, and any emergency department visit. The primary predictors were measures of provider volume and patient sharing across surgeons and medical oncologists. Regression analyses adjusted for patient and provider characteristics. RESULTS:Patients whose surgeons shared >40% of their colorectal cancerpatients in the previous year with a medical oncologist were (1) more likely to have had a consultation with a medical oncologist [marginal effect (ME)=13.3 percentage points, P-value<0.001], (2) less likely to receive a surveillance colonoscopy within 12 months (ME=3.5 percentage points, P-value=0.049), and (3) received more radiology studies (ME=0.254 studies, P-value=0.029). Patients whose surgeon and medical oncologist shared >20% of their colorectal cancerpatients with each other in the previous year had a higher likelihood of receiving adjuvant chemotherapy (ME=11.5 percentage points, P-value<0.001) and surveillance colonoscopy within 12 months (ME=6.7 percentage points, P-value=0.030) and within 18 months (ME=6.2 percentage points, P-value=0.054). CONCLUSIONS: Our study shows that team experience is associated with patients' quality of care, survival, and utilization.
Authors: Justin G Trogdon; W H Weir; S Shai; P J Mucha; T M Kuo; A M Meyer; K B Stitzenberg Journal: J Gen Intern Med Date: 2019-04-03 Impact factor: 5.128
Authors: Tufia Haddad; Jane M Helgeson; Katharine E Pomerleau; Anita M Preininger; M Christopher Roebuck; Irene Dankwa-Mullan; Gretchen Purcell Jackson; Matthew P Goetz Journal: JMIR Med Inform Date: 2021-03-26
Authors: Justin G Trogdon; Krutika Amin; Parul Gupta; Benjamin Y Urick; Katherine E Reeder-Hayes; Joel F Farley; Stephanie B Wheeler; Lisa Spees; Jennifer L Lund Journal: PLoS One Date: 2021-11-29 Impact factor: 3.240