Patient, hospital, and geographic disparities associated with comanagement during hospitalization for colorectal cancer surgery.
BACKGROUND
Comanagement of surgical patients has increased, but information regarding detailed characteristics of patients receiving comanagement during hospitalization for colorectal cancer (CRC) surgery is lacking.


OBJECTIVE
To examine the use of and characteristics associated with comanagement of patients hospitalized for CRC surgery.


METHODS
This study used a population-based cross-sectional design.


METHODS
We used the linked 2000 to 2005 Surveillance, Epidemiology, and End Results and Medicare claims data.


METHODS
We included 37,065 patients aged 66 years or older, hospitalized for definitive CRC surgery following stage I to III diagnosis.


METHODS
The outcome of interest was comanagement during hospitalization for CRC surgery, and we examined the association between several patient and hospital characteristics. Comanagement was defined as having a relevant physician (ie, internal medicine hospitalist/generalist) submit a claim for evaluation and management services on 70% or more of the days of hospitalization of the patient.


RESULTS
During hospitalization for CRC surgery, 27.6% of patients were comanaged, but this percentage varied widely across hospitals (from 1.9% to 83.2%). Several patient and hospital characteristics were associated with the use of comanaged care, of which important characteristics included older age at diagnosis, presence of comorbidity, emergency surgery, and hospital volume.


CONCLUSIONS
Extensive variability existed in comanagement use across patients and hospitals, likely reflecting the lack of evidence for its clinical effectiveness.
Department of Medicine, Division of Health Behavior Research, Washington University School of Medicine, St. Louis, Missouri.
Simone
S
de Vries
Donna B
DB
Jeffe
Sandi L
SL
Pruitt
Nicholas O
NO
Davidson
Mario
M
Schootman
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities; D006742:Hospital Bed Capacity; D020445:Hospitalists / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors