title: Outcome disparities between medical personnel and nonmedical personnel patients receiving definitive surgery for colorectal cancer: a nationwide population-based study.
abstract: Disparities in quality of care have always been a major challenge in health care. Providing information to patients may help to narrow such disparities. However, the relationship between level of patient information and outcomes remains to be explored. More importantly, would better-informed patients have better outcomes through their choice of higher quality providers? We hypothesize that medical professionals may have better outcomes than nonmedical professionals following definitive surgery for colorectal cancer (CRC), and their choice of provider may mediate this relationship. We identified 61,728 patients with CRC receiving definitive surgery between 2005 and 2011 from the Taiwan National Health Insurance Research Database. Medical professionals were identified via the registry for medical personnel. Indicators for surgical outcome such as emergency room (ER) visits within 30 days, medical expenses, length of hospital stay (LOS), and 5-year mortality were analyzed by using fixed and random effects multivariate regression models. Compared with nonmedical personnel CRC patients, a greater proportion of medical personnel received definitive surgery from higher volume surgeons (median 390 vs 311 within the study period) and/or in higher volume hospitals (median 1527 vs 1312 within the study period). CRC patients who are medical personnel had a shorter median LOS (12 vs 14 days), lower median medical expenses (112,687 vs 121,332 New Taiwan dollars), a lower ER visit rate within 30 days (11.3% vs 13.0%), and lower 5-year mortality. After adjusting for patient characteristics, medical personnel had a significantly lower hazard of 5-year mortality, and were significantly more likely to have a LOS shorter than 14 days than their nonmedical personnel counterparts. However, after adjusting for patient and provider characteristics, while medical personnel were significantly less likely to have a long LOS, no significant difference was observed in 5-year mortality between the 2 groups. Medical personnel did have a significantly better survival outcome and a shorter length of stay following definitive surgery than nonmedical personnel patients. The outcome disparities can be partially explained by characteristics of their treatment providers. The findings may serve as an important reference for better understanding how information may narrow gaps in quality of care through better choice of providers.
authors: From the Division of Hematology and Oncology (C-JL, Y-TL), Department of Medicine, Taipei Veterans General Hospital; School of Medicine (C-JL, C-CL, Y-WH, T-JC); Institute of Public Health (C-JL, Y-JC); Institute of Hospital and Health Care Administration (NH), National Yang-Ming University; Division of Colon and Rectal Surgery (C-CL), Department of Surgery; Cancer Center (Y-WH); Department of Family Medicine (C-MY, T-JC), Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chia-Jen
authors: CJ
authors: Liu
authors: Nicole
authors: N
authors: Huang
authors: Chun-Chi
authors: CC
authors: Lin
authors: Yu-Ting
authors: YT
authors: Lee
authors: Yu-Wen
authors: YW
authors: Hu
authors: Chiu-Mei
authors: CM
authors: Yeh
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Yiing-Jenq
authors: YJ
authors: Chou
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries; D013624:Taiwan / Q000453:epidemiology
references: J Gastrointest Surg. 2011 Dec;15(12):2239-45
references: 21993974
references: Surgery. 2008 Mar;143(3):343-51
references: 18291255
references: Ann Surg Oncol. 2006 Sep;13(9):1182-8
references: 16897270
references: J Clin Oncol. 2000 Jun;18(11):2327-40
references: 10829054
references: J Clin Oncol. 2003 Aug 1;21(15):2912-9
references: 12885809
references: Plast Reconstr Surg. 2008 Jul;122(1):133-139
references: 18594396
references: JAMA. 2000 Dec 20;284(23):3028-35
references: 11122590
references: PLoS One. 2012;7(7):e40590
references: 22815771
references: N Engl J Med. 1974 May 9;290(19):1051-5
references: 4821907
references: Surg Oncol. 2013 Sep;22(3):178-83
references: 23796402
references: Arch Surg. 2007 Jan;142(1):17-22
references: 17224496
references: Eur J Surg Oncol. 2008 Jan;34(1):23-9
references: 17890043
references: J Gastrointest Surg. 2009 Dec;13(12):2284-91
references: 19730957
references: Qual Saf Health Care. 2004 Apr;13(2):98-101
references: 15069215
references: Health Policy. 2010 Jan;94(1):61-7
references: 19762105
references: Health Serv Res. 2013 Feb;48(1):26-46
references: 22670835
references: Clin Otolaryngol. 2010 Feb;35(1):46-52
references: 20447162
references: J Clin Oncol. 2003 Feb 1;21(3):401-5
references: 12560426
references: Am J Respir Crit Care Med. 2008 May 1;177(9):989-94
references: 18263804
references: Surg Oncol. 2011 Jun;20(2):e72-7
references: 21071208
references: Br J Surg. 2006 Oct;93(10):1297-302
references: 16862611
references: Colorectal Dis. 2013 May;15(5):559-65
references: 23061638
references: J Clin Oncol. 2009 Aug 1;27(22):3677-83
references: 19470929
references: Dis Colon Rectum. 2008 Feb;51(2):154-61
references: 18172729
references: N Engl J Med. 2003 Nov 27;349(22):2117-27
references: 14645640
references: Br J Cancer. 2003 Aug 4;89(3):487-91
references: 12888817
references: Prev Med. 2007 Jun;44(6):531-5
references: 17467786
references: Breast Cancer Res Treat. 2008 Jul;110(2):349-56
references: 17874183
references: JAMA. 1998 Dec 16;280(23):2039-42
references: 9863860
references: Arch Intern Med. 1988 Nov;148(11):2433-6
references: 3190374
references: Ann Surg. 2002 Apr;235(4):449-57
references: 11923599
references: BMC Health Serv Res. 2013 Jul 23;13:284
references: 23879804
references: J Occup Health. 2013;55(3):158-66
references: 23574776
references: N Engl J Med. 2002 Apr 11;346(15):1128-37
references: 11948273
references: J Gen Intern Med. 1995 May;10(5):261-5
references: 7616335