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Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Disparities in utilization of post-discharge care and overall expenditures may relate to site of care and race/ethnicity. We sought to define the impact of minority-serving hospitals (MSHs) on postoperative outcomes, discharge disposition, and overall expenditures associated with an episode of surgical care.

Methods

Patients who underwent resection for esophageal, colon, rectal, pancreatic, and liver cancer were identified from Medicare Standard Analytic Files (2013–2017). A MSH was defined as the top decile of facilities treating minority patients (Black and/or Hispanic). The impact of MSH on outcomes of interest was analyzed using multivariable logistic regression and generalized linear regression models. Textbook outcome (TO) was defined as no postoperative complications, no prolonged length of stay, and no 90-day mortality or readmission.

Results

Among 113,263 patients, only a small subset of patients underwent surgery at MSHs (n = 4404, 3.9%). While 52.3% of patients achieved TO, rates were lower at MSHs (MSH: 47.2% vs. non-MSH: 52.5%; p < 0.001). On multivariable analysis, receiving care at an MSH was associated with not achieving TO (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.76–0.87) and concomitantly higher odds of additional post-discharge care (OR 1.10, 95% CI 1.01–1.20). Patients treated at an MSH also had higher median post-discharge expenditures (MSH: $8400, interquartile range [IQR] $2300–$22,100 vs. non-MSH: $7000, IQR $2200–$17,900; p = 0.002). In fact, MSHs remained associated with a 11.05% (9.78–12.33%) increase in index expenditures and a 16.68% (11.44–22.17%) increase in post-discharge expenditures.

Conclusions

Patients undergoing surgery at a MSH were less likely to achieve a TO. Additionally, MSH status was associated with a higher likelihood of requiring post-discharge care and higher expenditures.

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References

  1. Institute of Medicine (US) Committee on understanding and eliminating racial and ethnic disparities in health care, Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.

  2. Virnig BA, Baxter NN, Habermann EB, Feldman RD, Bradley CJ. A matter of race: early-versus late-stage cancer diagnosis. Health Aff (Millwood). 2009;28(1):160–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Haider AH, Scott VK, Rehman KA, et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg. 2013;216(3):482-92.e12.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.

    Article  PubMed  Google Scholar 

  5. Torain MJ, Maragh-Bass AC, Dankwa-Mullen I, et al. Surgical disparities: a comprehensive review and new conceptual framework. J Am Coll Surg. 2016;223(2):408–18.

    Article  PubMed  Google Scholar 

  6. Haider AH, Schneider EB, Sriram N, et al. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. JAMA Surg. 2015;150(5):457–64.

    Article  PubMed  Google Scholar 

  7. Cole AP, Nguyen DD, Meirkhanov A, et al. Association of care at minority-serving vs non-minority-serving hospitals with use of palliative care among racial/ethnic minorities with metastatic cancer in the united states. JAMA Netw Open. 2019;2(2):e187633.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fletcher SA, Gild P, Cole AP, et al. The effect of treatment at minority-serving hospitals on outcomes for bladder cancer. Urol Oncol. 2018;36(5):238.e7-238.e17.

    Article  PubMed  Google Scholar 

  9. Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82.

    Article  PubMed  Google Scholar 

  10. Lima HA, Alaimo L, Moazzam Z, et al. Disparities in NCCN guideline-compliant care for patients with early-stage pancreatic adenocarcinoma at minority-serving versus non-minority-serving hospitals. Ann Surg Oncol. 2023;30(7):4373–4. https://doi.org/10.1245/s10434-023-13230-y.

    Article  PubMed  Google Scholar 

  11. Tsilimigras DI, Dalmacy D, Hyer JM, Diaz A, Abbas A, Pawlik TM. Disparities in NCCN guideline compliant care for resectable cholangiocarcinoma at minority-serving versus non-minority-serving hospitals. Ann Surg Oncol. 2021;28(13):8162–71.

    Article  PubMed  Google Scholar 

  12. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for medicare beneficiaries by race and site of care. JAMA. 2011;305(7):675–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Haider AH, Ong’uti S, Efron DT, et al. Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals. Arch Surg. 2012;147(1):63–70.

    Article  PubMed  Google Scholar 

  14. Faigle R, Ziai WC, Urrutia VC, Cooper LA, Gottesman RF. Racial differences in palliative care use after stroke in majority-white, minority-serving, and racially integrated U. S. Hospitals. Crit Care Med. 2017;45(12):2046–54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hyer JM, Paredes AZ, Cerullo M, et al. Assessing post-discharge costs of hepatopancreatic surgery: an evaluation of medicare expenditure. Surgery. 2020;167(6):978–84.

    Article  PubMed  Google Scholar 

  16. Endo Y, Moazzam Z, Woldesenbet S, et al. Hospital volume and textbook outcomes in minimally invasive hepatectomy for hepatocellular carcinoma. J Gastrointest Surg. 2023;27(5):956–64. https://doi.org/10.1007/s11605-023-05609-9.

    Article  PubMed  Google Scholar 

  17. Moazzam Z, Alaimo L, Lima HA, Endo Y, Pawlik TM. The impact of race/ethnicity and county-level upward economic mobility on textbook outcomes in hepatopancreatic surgery. Surgery. 2023;173(5):1192–8.

    Article  PubMed  Google Scholar 

  18. Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700–15.

    Article  CAS  PubMed  Google Scholar 

  19. Hyer JM, Ejaz A, Diaz A, et al. Characterizing and assessing the impact of surgery on healthcare spending among medicare enrolled preoperative super-utilizers. Ann Surg. 2019;270(3):554–63.

    Article  PubMed  Google Scholar 

  20. Donald Hedeker RG. Longitudinal data analysis. Hoboken: Wiley; 2006.

    Book  Google Scholar 

  21. Himmelstein G, Ceasar JN, Himmelstein KE. Hospitals that serve many black patients have lower revenues and profits: structural racism in hospital financing. J Gen Intern Med. 2023;38(3):586–91.

    Article  PubMed  Google Scholar 

  22. Graham LA, Mull HJ, Wagner TH, et al. Comparison of a potential hospital quality metric with existing metrics for surgical quality-associated readmission. JAMA Netw Open. 2019;2(4):e191313.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kneuertz PJ, Pitt HA, Bilimoria KY, et al. Risk of morbidity and mortality following Hepato-Pancreato-biliary surgery. J Gastrointest Surg. 2012;16(9):1727–35.

    Article  PubMed  Google Scholar 

  24. Kolfschoten NE, Kievit J, Gooiker GA, et al. Focusing on desired outcomes of care after colon cancer resections; hospital variations in ‘textbook outcome.’ Eur J Surg Oncol. 2013;39(2):156–63.

    Article  CAS  PubMed  Google Scholar 

  25. Merath K, Chen Q, Bagante F, et al. A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. JAMA Surg. 2019;154(6):e190571.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kantor O, Chang C, Yao K, et al. Uptake of breast cancer clinical trials at minority serving cancer centers. Ann Surg Oncol. 2021;28(9):4995–5004.

    Article  PubMed  Google Scholar 

  27. Krimphove MJ, Fletcher SA, Cole AP, et al. Quality of care in the treatment of localized intermediate and high risk prostate cancer at minority serving hospitals. J Urol. 2019;201(4):735–41.

    Article  PubMed  Google Scholar 

  28. Lu PW, Scully RE, Fields AC, et al. Racial disparities in treatment for rectal cancer at minority-serving hospitals. J Gastrointest Surg. 2021;25(7):1847–56.

    Article  PubMed  Google Scholar 

  29. Gottlieb-Vedi E, Mattsson F, Lagergren P, Lagergren J. Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis. Eur J Surg Oncol. 2019;45(10):1839–46.

    Article  PubMed  Google Scholar 

  30. Zogg CK, Jiang W, Chaudhary MA, et al. Racial disparities in emergency general surgery: do differences in outcomes persist among universally insured military patients? J Trauma Acute Care Surg. 2016;80(5):764–75.

    Article  PubMed  Google Scholar 

  31. Merath K, Chen Q, Bagante F, et al. Textbook outcomes among medicare patients undergoing hepatopancreatic surgery. Ann Surg. 2020;271(6):1116–23.

    Article  PubMed  Google Scholar 

  32. Kaye DR, Luckenbaugh AN, Oerline M, et al. Understanding the costs associated with surgical care delivery in the medicare population. Ann Surg. 2020;271(1):23–8.

    Article  PubMed  Google Scholar 

  33. Nathan H, Atoria CL, Bach PB, et al. Hospital volume, complications, and cost of cancer surgery in the elderly. J Clin Oncol. 2015;33(1):107–14.

    Article  PubMed  Google Scholar 

  34. Sheetz KH, Ibrahim AM, Regenbogen SE, et al. Surgeon experience and medicare expenditures for laparoscopic compared to open colectomy. Ann Surg. 2018;268(6):1036–42.

    Article  PubMed  Google Scholar 

  35. Birkmeyer JD, Gust C, Baser O, et al. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res. 2010;45(6 Pt 1):1783–95.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Shubeck SP, Thumma JR, Dimick JB, Nathan H. Hot spotting as a strategy to identify high-cost surgical populations. Ann Surg. 2019;269(3):453–8.

    Article  PubMed  Google Scholar 

  37. Donohue JM, Normand SL, Horvitz-Lennon M, Men A, Berndt ER, Huskamp HA. Regional variation in physician adoption of antipsychotics: impact on US medicare expenditures. J Ment Health Policy Econ. 2016;19(2):69–78.

    PubMed  PubMed Central  Google Scholar 

  38. Hyer JM, Ejaz A, Tsilimigras DI, Paredes AZ, Mehta R, Pawlik TM. Novel machine learning approach to identify preoperative risk factors associated with super-utilization of medicare expenditure following surgery. JAMA Surg. 2019;154(11):1014–21.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Pradarelli JC, Scally CP, Nathan H, Thumma JR, Dimick JB. Hospital teaching status and medicare expenditures for complex surgery. Ann Surg. 2017;265(3):502–13.

    Article  PubMed  Google Scholar 

  40. Borza T, Oreline MK, Skolarus TA, et al. Association of the hospital readmissions reduction program with surgical readmissions. JAMA Surg. 2018;153(3):243–50.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Henrique A. Lima MD, Selamawit Woldesenbet PhD, Zorays Moazzam MD, Yutaka Endo MD, PhD, Muhammad Musaab Munir MD, Chanza Shaikh MD, Belisario Ortiz Rueda MD, Laura Alaimo MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

  2. Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

    Henrique A. Lima MD & Vivian Resende MD, PhD

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  1. Henrique A. Lima MD
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  2. Selamawit Woldesenbet PhD
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  3. Zorays Moazzam MD
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  4. Yutaka Endo MD, PhD
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Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Henrique A. Lima, Selamawit Woldesenbet, Zorays Moazzam, Yutaka Endo, Muhammad Musaab Munir, Chanza Shaikh, Belisario Ortiz Rueda, Laura Alaimo, Vivian Resende, and Timothy M. Pawlik have no disclosures to declare.

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Lima, H.A., Woldesenbet, S., Moazzam, Z. et al. Association of Minority-Serving Hospital Status with Post-Discharge Care Utilization and Expenditures in Gastrointestinal Cancer. Ann Surg Oncol 30, 7217–7225 (2023). https://doi.org/10.1245/s10434-023-14146-3

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