title: Colorectal cancer surgery outcomes for vulnerable patients in safety-net versus non-safety-net hospitals.
abstract: Extensive research documents disparities in health outcomes for vulnerable populations. Safety-net hospitals-those that serve a greater proportion of vulnerable patients with Medicaid or no insurance-may yield better outcomes for these vulnerable patients because of their expertise with this population. National Inpatient Sample data from 2005-2007 show that predicted rates of complications following colorectal cancer surgery are approximately 20% lower for vulnerable patients in safety-net than in non-safety-net hospitals (0.273 versus 0.340; 95% CI for the difference: -0.11, -0.001). Differences by safety-net status for Medicare and privately-insured patients were smaller and not statistically significant. The lower complication rates are not due to earlier discharge, as vulnerable patients had significantly longer stays at safety-net hospitals (1.79 days; 95% CI 0.13, 3.40). Additional research is needed to determine whether improvement in post-operative outcomes is due to the expertise of safety-net hospitals in caring for patients with Medicaid or no insurance.
authors.affiliation: North Carolina Community Health Center Association, Raleigh NC 27606, USA. whitakerr@ncchca.org
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Whitaker
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Reiter
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data*