title: Do hospitals that serve a high percentage of Medicaid patients perform well on evidence-based guidelines for colon cancer care?
abstract: BACKGROUND
  Previous work suggests hospitals serving high percentages of patients with Medicaid are associated with worse colon cancer survival. It is unclear if practice patterns in these settings explain differential outcomes.
  
  
  OBJECTIVE
  High Medicaid hospitals (HMH) have lower compliance with evidence-based care processes (examining 12 or more lymph nodes (LN) during surgical staging and providing appropriate chemo-therapy).
  
  
  METHODS
  Retrospective analysis of stage I-III colon cancers from California Cancer Registry (1996-2006) linked to discharge abstracts and hospital profiles predicted hospital compliance with guidelines and trends in compliance over time.
  
  
  RESULTS
  Cases (N=60,000) in 439 hospitals analyzed. High Medicaid hospital settings had lower odds of compliance with the 12 LN exam (OR(HMH)0.91, CI(HMH)[0.85, 0.98]) and with the delivery of appropriate chemotherapy (OR(HMH)0.76, CI(HMH)[0.67, 0.86]).
  
  
  CONCLUSIONS
  High Medicaid hospital status is associated with poor performance on evidence-based colon cancer care. Policies to improve the quality of colon cancer care should target these settings.
authors: Kim F
authors: KF
authors: Rhoads
authors: Justine V
authors: JV
authors: Ngo
authors: Yifei
authors: Y
authors: Ma
authors: Lyen
authors: L
authors: Huang
authors: Mark L
authors: ML
authors: Welton
authors: R Adams
authors: RA
authors: Dudley
mesh_terms: D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016001:Confidence Intervals; D055317:Evidence-Based Practice; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008507:Medically Underserved Area; D016017:Odds Ratio; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States