title: Patterns of hospital utilization for head and neck cancer care: changing demographics.
abstract: OBJECTIVE
  The care of patients with head and neck cancer (HNCA) is becoming increasingly regionalized to high-volume, more effective centers. However, it remains uncertain whether such care is equally distributed. Increasing our understanding of how HNCA treatment is utilized among different sectors should improve strategy designs aimed at ensuring optimized quality of care.
  
  
  OBJECTIVE
  To determine which patient- or treatment-associated factors may account for increased regionalization of HNCA care.
  
  
  METHODS
  Secondary analysis of all inpatient records of hospital admissions with a primary HNCA diagnosis contained within the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.
  
  
  METHODS
  Influence of comorbidities, payer, radiation therapy, and case complexity on regionalization of HNCA care to teaching institutions.
  
  
  RESULTS
  In the years 2000, 2005, and 2010, there were an estimated mean (SE) 28,862 (2067), 33,517 (3080), and 37,354 (4194) inpatient hospital HNCA stays, respectively, in the United States. Over time, the respective Charlson comorbidity index (CCI) scores (4.4 and 4.0) and Van Walraven scores (10.0 and 8.9) for nonteaching and teaching institutions were increasingly higher (P < .001). Payer status (private insurance vs Medicaid) did not change for teaching institutions (35.4% vs 33.3%) (P ≥ .63), but the proportion of Medicaid patients did increase over time for nonteaching institutions (10.2% vs 15.8%) (P = .002). Both teaching and nonteaching institutions saw an increase in proportion of prior irradiated cases (7.6% and 4.6% vs 3.4% and 1.9%, respectively) (P ≤ .02). The proportion of major ablative procedures was stable for teaching institutions over time (46.5% vs 43.3%) (P = .57) but decreased for nonteaching institutions (27.2% vs 32.6%) (P = .01). The proportion of flap reconstruction procedures increased over time for teaching institutions (8.6% vs 4.1%) (P < .001) but not for nonteaching institutions (2.7% vs 2.4%) (P = .21).
  
  
  CONCLUSIONS
  Despite the demonstrated link between excellence and outcomes and specialized resource-intensive care, the regionalization of head and neck oncologic treatment is becoming increasingly divergent, and the neediest, sickest patient groups are receiving less than optimal care.
authors: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors: Neil
authors: N
authors: Bhattacharyya
authors: Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors: Elliot
authors: E
authors: Abemayor
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology