How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

Abstract

Purpose Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities. Patients and Methods This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline–based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings. Results More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score–matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio [HR], 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race. Conclusion The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.

Factors Influencing Helmet Use, Head Injury, and Hospitalization Among Children Involved in Skateboarding and Snowboarding Accidents

“…4,56,57 The preoperative gallstone nomogram developed by Parmar et al 57 is a useful tool for predicting risk of recurrent gallstone complications and can help surgeons weigh the risk of nonoperative intervention against the risk of recurrence.…”

“…54 Although plentiful research has revealed the positive impact of addressing behavioral health issues in primary care settings and empirical evidence shows that integrated care can reduce health disparities, relatively little attention has focused on the unique needs of culturally diverse groups such as African Americans. 42,[55][56][57] A 2016 literature review concluded that "Evidence is lacking about the effectiveness of integrated care offered in a culturally and linguistically competent, patient-centered framework that adequately addresses key concerns and barriers that affect populations at great risk for marginal health." 58 To address this evidence gap, Project THRIVE (Towards Health Recovery and Vital Engagement) offers a promising approach.…”

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

“…24 In contrast, proactive screening programs based on population health management (PHM) principles can provide more uniform services to all eligible persons without relying on face-to-face office visits. [24][25][26][27] These programs have the potential to eliminate disparities in access to and utilization of CRC screening, 28 but their effectiveness in increasing uptake across diverse groups is unclear. 29 In 2005, Kaiser Permanente Northern California (KPNC) initiated a more comprehensive long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance.…”

Patient and Practitioner Perspectives on Culturally Centered Integrated Care to Address Health Disparities in Primary Care

“…54 Although plentiful research has revealed the positive impact of addressing behavioral health issues in primary care settings and empirical evidence shows that integrated care can reduce health disparities, relatively little attention has focused on the unique needs of culturally diverse groups such as African Americans. 42,[55][56][57] A 2016 literature review concluded that "Evidence is lacking about the effectiveness of integrated care offered in a culturally and linguistically competent, patient-centered framework that adequately addresses key concerns and barriers that affect populations at great risk for marginal health." 58 To address this evidence gap, Project THRIVE (Towards Health Recovery and Vital Engagement) offers a promising approach.…”