The Effects of Hospital Characteristics on Delays in Breast Cancer Diagnosis in Appalachian Communities: A Population-Based Study

被引:6
作者
Louis, Christopher J. [1 ]
Clark, Jonathan R. [2 ]
Hillemeier, Marianne M. [3 ]
Camacho, Fabian [4 ]
Yao, Nengliang [4 ]
Anderson, Roger T. [4 ]
机构
[1] Boston Univ, Dept Hlth Law Policy & Management, 261 Talbot, Boston, MA 02118 USA
[2] Univ Texas San Antonio, Coll Business, San Antonio, TX USA
[3] Penn State Univ, Dept Hlth Policy & Adm, University Pk, PA 16802 USA
[4] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA
关键词
Appalachia; breast cancer; hospitals; medicare; rural areas; PATIENT NAVIGATION; RACIAL-DIFFERENCES; RADIATION-THERAPY; FOLLOW-UP; SURVIVAL; VOLUME; WOMEN; IMPACT; COMORBIDITY; DISPARITIES;
D O I
10.1111/jrh.12226
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
PurposeDespite being generally accepted that delays in diagnosing breast cancer are of prognostic and psychological concern, the influence of hospital characteristics on such delays remains poorly understood, especially in rural and underserved areas. However, hospital characteristics have been tied to greater efficiency and warrant further investigation as they may have implications for breast cancer care in these areas. MethodsStudy data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008). We then linked Medicare enrollment files and claims data (2005-2009), the Area Resource File (2006-2008), and the American Hospital Association Annual Survey of Hospitals (2007) to create an integrated data set. Hierarchical linear modeling was used to regress the natural log of breast cancer diagnosis delay on a number of hospital-level, demographic, and clinical characteristics. FindingsThe baseline study sample consisted of 4,547 breast cancer patients enrolled in Medicare that lived in Appalachian counties at the time of diagnosis. We found that hospitals with for-profit ownership (P < .01) had shorter diagnosis delays than their counterparts. Estimates for comprehensive oncology services, system membership and size were not statistically significant at conventional levels. ConclusionsSome structural characteristics of hospitals (eg, for-profit ownership) in the Appalachian region are associated with having shorter delays in diagnosing breast cancer. Researchers and practitioners must go beyond examining patient-level demographic and tumor characteristics to better understand the drivers of timely cancer diagnosis, especially in rural and underserved areas.
引用
收藏
页码:S91 / S103
页数:13
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