3 Citations (Scopus)

Abstract

We studied differences in access to large or accredited cancer programs as a possible explanation for geographic disparities in adherence to the national guideline on lymph node assessment for Stages I to III colon cancer. State cancer registries were linked with Medicare claims of patients diagnosed from 2006 to 2008 from Appalachian counties of four states. Metropolitan and nonmetropolitan patients differed on adherence, proximity to high-volume or accredited hospitals, and hospital type. We modeled effects of hospital type on adherence with ordinary least squares and instrumental variables (instrumenting for hospital type with relative distance). The evidence was strongest for improved adherence in high-volume hospitals for nonmetropolitan patients. We estimate that roughly 100 deaths might be prevented over 5 years among each year's incident cases if the nonmetropolitan disparity in hospital volume were eliminated nationally. We conclude that regionalization or targeting smaller hospitals would improve adherence in nonmetropolitan areas, but also argue for improving adherence generally.

Original languageEnglish (US)
Pages (from-to)546-564
Number of pages19
JournalMedical Care Research and Review
Volume73
Issue number5
DOIs
StatePublished - Oct 1 2016

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Appalachian Region
Colonic Neoplasms
Lymph Nodes
High-Volume Hospitals
Medicare
Least-Squares Analysis
Registries
Neoplasms
Guidelines

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

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title = "Effects of hospital type and distance on lymph node assessment for colon cancer among metropolitan and nonmetropolitan patients in appalachia",
abstract = "We studied differences in access to large or accredited cancer programs as a possible explanation for geographic disparities in adherence to the national guideline on lymph node assessment for Stages I to III colon cancer. State cancer registries were linked with Medicare claims of patients diagnosed from 2006 to 2008 from Appalachian counties of four states. Metropolitan and nonmetropolitan patients differed on adherence, proximity to high-volume or accredited hospitals, and hospital type. We modeled effects of hospital type on adherence with ordinary least squares and instrumental variables (instrumenting for hospital type with relative distance). The evidence was strongest for improved adherence in high-volume hospitals for nonmetropolitan patients. We estimate that roughly 100 deaths might be prevented over 5 years among each year's incident cases if the nonmetropolitan disparity in hospital volume were eliminated nationally. We conclude that regionalization or targeting smaller hospitals would improve adherence in nonmetropolitan areas, but also argue for improving adherence generally.",
author = "Short, {Pamela Farley} and {Moran, Jr.}, {John Raymond} and Yang, {Tse Chuan} and Fabian Camacho and Gusani, {Niraj J.} and Heath Mackley and Matthews, {Stephen Augustus} and Anderson, {Roger T.}",
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Effects of hospital type and distance on lymph node assessment for colon cancer among metropolitan and nonmetropolitan patients in appalachia. / Short, Pamela Farley; Moran, Jr., John Raymond; Yang, Tse Chuan; Camacho, Fabian; Gusani, Niraj J.; Mackley, Heath; Matthews, Stephen Augustus; Anderson, Roger T.

In: Medical Care Research and Review, Vol. 73, No. 5, 01.10.2016, p. 546-564.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Effects of hospital type and distance on lymph node assessment for colon cancer among metropolitan and nonmetropolitan patients in appalachia

AU - Short, Pamela Farley

AU - Moran, Jr., John Raymond

AU - Yang, Tse Chuan

AU - Camacho, Fabian

AU - Gusani, Niraj J.

AU - Mackley, Heath

AU - Matthews, Stephen Augustus

AU - Anderson, Roger T.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - We studied differences in access to large or accredited cancer programs as a possible explanation for geographic disparities in adherence to the national guideline on lymph node assessment for Stages I to III colon cancer. State cancer registries were linked with Medicare claims of patients diagnosed from 2006 to 2008 from Appalachian counties of four states. Metropolitan and nonmetropolitan patients differed on adherence, proximity to high-volume or accredited hospitals, and hospital type. We modeled effects of hospital type on adherence with ordinary least squares and instrumental variables (instrumenting for hospital type with relative distance). The evidence was strongest for improved adherence in high-volume hospitals for nonmetropolitan patients. We estimate that roughly 100 deaths might be prevented over 5 years among each year's incident cases if the nonmetropolitan disparity in hospital volume were eliminated nationally. We conclude that regionalization or targeting smaller hospitals would improve adherence in nonmetropolitan areas, but also argue for improving adherence generally.

AB - We studied differences in access to large or accredited cancer programs as a possible explanation for geographic disparities in adherence to the national guideline on lymph node assessment for Stages I to III colon cancer. State cancer registries were linked with Medicare claims of patients diagnosed from 2006 to 2008 from Appalachian counties of four states. Metropolitan and nonmetropolitan patients differed on adherence, proximity to high-volume or accredited hospitals, and hospital type. We modeled effects of hospital type on adherence with ordinary least squares and instrumental variables (instrumenting for hospital type with relative distance). The evidence was strongest for improved adherence in high-volume hospitals for nonmetropolitan patients. We estimate that roughly 100 deaths might be prevented over 5 years among each year's incident cases if the nonmetropolitan disparity in hospital volume were eliminated nationally. We conclude that regionalization or targeting smaller hospitals would improve adherence in nonmetropolitan areas, but also argue for improving adherence generally.

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