Katelyn K Jetelina1,2, Simon Craddock Lee3,4, Quiera S Booker-Nubie1, Udoka C Obinwa5, Hong Zhu2,6, Michael E Miller6, Navid Sadeghi2,7,8, Umber Dickerson8, Bijal A Balasubramanian1,2. 1. Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA. 2. Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA. 3. Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA. simoncraddock.lee@utsouthwestern.edu. 4. Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA. simoncraddock.lee@utsouthwestern.edu. 5. Dallas Department of Health and Human Services, Dallas, TX, USA. 6. Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA. 7. Department of Internal Medicine, Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, TX, USA. 8. Parkland Health & Hospital System, Dallas, TX, USA.
Abstract
PURPOSE: To understand the impact of pre-existing conditions on healthcare utilization among under- and uninsured patients in the transition from cancer treatment to post-treatment survivorship. METHODS: Using electronic health record data, we constructed a cohort of patients seen in an integrated county health system between 1/1/2010 and 12/31/2016. Six hundred thirty-one adult patients diagnosed with non-metastatic breast or colorectal cancer during this period (cases) were matched 1:1 on sex and Charlson comorbidity index to non-cancer patients who had at least two chronic conditions and with at least one visit to the health system during the study period (controls). Conditional fixed effects Poisson regression models compared number of primary care and emergency department (ED) visits and completed [vs. no show or missed] appointments between cancer and non-cancer patients. RESULTS: Cancer patients had significantly lower number of visits compared with non-cancer patients (N = 46,965 vs. 85,038). Cancer patients were less likely to have primary care (IRR = 0.25; 95% CI: 0.24, 0.27) and ED visits (IRR = 0.57; 95% CI: 0.50, 0.64) but more likely to complete a scheduled appointment (AOR = 4.83; 95% CI: 4.32, 5.39) compared with non-cancer patients. Cancer patients seen in primary care at a higher rate were more likely to visit the ED (IRR = 2.06; 95% CI: 1.52, 2.80) than those seen in primary care at a lower rate. CONCLUSION: Health systems need to find innovative, effective solutions to increase primary care utilization among cancer patients with chronic care conditions to ensure optimal management of both chronic conditions and cancer. IMPLICATIONS FOR CANCER SURVIVORS: Maintaining regular connections with primary care providers during active cancer treatment should be promoted.
PURPOSE: To understand the impact of pre-existing conditions on healthcare utilization among under- and uninsured patients in the transition from cancer treatment to post-treatment survivorship. METHODS: Using electronic health record data, we constructed a cohort of patients seen in an integrated county health system between 1/1/2010 and 12/31/2016. Six hundred thirty-one adult patients diagnosed with non-metastatic breast or colorectal cancer during this period (cases) were matched 1:1 on sex and Charlson comorbidity index to non-cancer patients who had at least two chronic conditions and with at least one visit to the health system during the study period (controls). Conditional fixed effects Poisson regression models compared number of primary care and emergency department (ED) visits and completed [vs. no show or missed] appointments between cancer and non-cancer patients. RESULTS: Cancer patients had significantly lower number of visits compared with non-cancer patients (N = 46,965 vs. 85,038). Cancer patients were less likely to have primary care (IRR = 0.25; 95% CI: 0.24, 0.27) and ED visits (IRR = 0.57; 95% CI: 0.50, 0.64) but more likely to complete a scheduled appointment (AOR = 4.83; 95% CI: 4.32, 5.39) compared with non-cancer patients. Cancer patients seen in primary care at a higher rate were more likely to visit the ED (IRR = 2.06; 95% CI: 1.52, 2.80) than those seen in primary care at a lower rate. CONCLUSION: Health systems need to find innovative, effective solutions to increase primary care utilization among cancer patients with chronic care conditions to ensure optimal management of both chronic conditions and cancer. IMPLICATIONS FOR CANCER SURVIVORS: Maintaining regular connections with primary care providers during active cancer treatment should be promoted.
Authors: Carla Parry; Erin E Kent; Angela B Mariotto; Catherine M Alfano; Julia H Rowland Journal: Cancer Epidemiol Biomarkers Prev Date: 2011-10 Impact factor: 4.254
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Authors: Caitlin R Finley; Derek S Chan; Scott Garrison; Christina Korownyk; Michael R Kolber; Sandra Campbell; Dean T Eurich; Adrienne J Lindblad; Ben Vandermeer; G Michael Allan Journal: Can Fam Physician Date: 2018-11 Impact factor: 3.275