Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions

Abstract

Purpose To examine cancer treatment disparities at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC) and non-specialty hospitals. Materials and Methods Florida hospital discharge datasets were used. ICD9-CM codes were used to define patients with female reproductive organ cancers (FROC), male reproductive organ cancers (MROC), and OTHER cancer diagnoses. A total of 7462 NCI-CCC patients and 21,875 non-specialty hospital patients were included in the statistical analysis. Data analysis was conducted in SAS 9.2.Results Increases in age reduced the odds of receiving treatment at the NCI-CCC. Male patients were more likely than female patients to be treated at the NCI-CCC. Age-adjusted odds of African American and Hispanic out/inpatients being treated at the NCI-CCC were significantly lower than those of White out/inpatients. Only patients with workers' compensation, charity, or other insurance had higher odds of being treated at the NCI-CCC. The odds of minority patients receiving outpatient treatment at the NCI-CCC declined after 2005. The odds of receiving inpatient treatment at the NCI-CCC significantly increased after 2006. Conclusions More targeted outreach by the NCI-CCC is required. However, we expect the creation of local Accountable Care Organizations (ACOs) to reduce the numbers of minority and older patients at the NCI-CCC. Coordinated quality care at ACOs implies a potential for retaining the patient market share held by non-specialty hospitals and a potential for increased demand for ACO care by minority and older patients.

Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

“…4,17,19 Racial disparities in access to surgical intervention and outcomes are widely documented for African Americans and other minorities in the United States. [1][2][3][4][5][6][7][8][9][10][11][12][13] In the modern era of healthcare reform, efforts such as ACOs and Medical Homes were touted as initiatives that would not only reduce costs and improve care, but also ameliorate disparities in the healthcare system. 16,17,24 However, the mechanisms by which ACOs would impact healthcare disparities, especially when it comes to surgical interventions, were not well described.…”

“…(Ann Surg 2019;269:459-464) R acial and ethnic minorities often receive lower quality healthcare than non-Hispanic whites, even after accounting for insurance, socioeconomic status, comorbidities, and patient preferences. [1][2][3][4][5][6][7][8][9][10][11][12][13] This includes reduced access to surgical services. 5 -8,11,12 Skinner et al 5 reported that in the Medicare population African Americans and Hispanics were less likely to receive knee arthroplasty as compared to whites, whereas Sultan et al 13 documented reduced access among African Americans and Hispanic patients at National Cancer Institute-Designated Comprehensive Cancer Centers.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] This includes reduced access to surgical services. 5 -8,11,12 Skinner et al 5 reported that in the Medicare population African Americans and Hispanics were less likely to receive knee arthroplasty as compared to whites, whereas Sultan et al 13 documented reduced access among African Americans and Hispanic patients at National Cancer Institute-Designated Comprehensive Cancer Centers. Major national organizations such as the National Academy of Medicine and the Robert Wood Johnson Foundation have called for design and implementation of programs and initiatives to reduce such disparities.…”

Personal Mastery and the Medical, Financial, and Physical Cancer Burden: Gender and Race Differences Among Older Adults

“…When diagnosed with cancer, White men's higher SES and advantage in health-enhancing resources allow them to obtain prompt access to high-quality medical care, more aggressive therapies, and better follow-up monitoring (Aizer et al, 2014;Dolly et al, 2016;Moses et al, 2016;Ziehr et al, 2015). White men with cancer are more likely than minority and female patients to be treated at National Cancer Institute-Designated Comprehensive Cancer Centers, which are at the forefront of innovation and cuttingedge technologies (Sultan et al, 2015). Black patients experience a longer delay from the diagnosis to treatment and also receive fewer procedures to mitigate treatment side effects than White patients (Bustami et al, 2014;Gupta et al, 2016).…”

Racial/Ethnic and Insurance Status Disparities in Distance Traveled to Access Children’s Hospital Care for Severe Illness: the Case of Children with Leukodystrophies

“…Specialty hospitals often benefit patients in terms of quality, efficiency, and cost of care [14]. However, social disparities can impact which families obtain access to specialty care [15,16]. A literature review found that children with public insurance have poorer access to specialty care than children with private insurance [17].…”