title: How do integrated health care systems address racial and ethnic disparities in colon cancer?
abstract: OBJECTIVE
  Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities.
  
  
  METHODS
  This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline-based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings.
  
  
  RESULTS
  More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score-matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio [HR], 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race.
  
  
  CONCLUSIONS
  The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.
authors.affiliation: Kim F. Rhoads and Yifei Ma, Stanford Cancer Institute; Kim F. Rhoads, Manali I. Patel, and Yifei Ma, Stanford University School of Medicine, Stanford; and Laura A. Schmidt, University of California San Francisco Philip R. Lee Institute for Health Policy Studies, San Francisco, CA. kim.rhoads@stanford.edu.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
authors.affiliation: Kim F. Rhoads and Yifei Ma, Stanford Cancer Institute; Kim F. Rhoads, Manali I. Patel, and Yifei Ma, Stanford University School of Medicine, Stanford; and Laura A. Schmidt, University of California San Francisco Philip R. Lee Institute for Health Policy Studies, San Francisco, CA.
authors.forename: Manali I
authors.initials: MI
authors.lastname: Patel
authors.affiliation: Kim F. Rhoads and Yifei Ma, Stanford Cancer Institute; Kim F. Rhoads, Manali I. Patel, and Yifei Ma, Stanford University School of Medicine, Stanford; and Laura A. Schmidt, University of California San Francisco Philip R. Lee Institute for Health Policy Studies, San Francisco, CA.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Kim F. Rhoads and Yifei Ma, Stanford Cancer Institute; Kim F. Rhoads, Manali I. Patel, and Yifei Ma, Stanford University School of Medicine, Stanford; and Laura A. Schmidt, University of California San Francisco Philip R. Lee Institute for Health Policy Studies, San Francisco, CA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002648:Child; D002675:Child, Preschool; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005006:Ethnicity; D005260:Female; D018166:Health Care Reform; D006302:Health Services Research; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult