title: Factors that influence minority use of high-volume hospitals for colorectal cancer care.
abstract: BACKGROUND
  Previous studies suggest that minorities cluster in low-quality hospitals despite living close to better performing hospitals. This may contribute to persistent disparities in cancer outcomes.
  
  
  OBJECTIVE
  The purpose of this work was to examine how travel distance, insurance status, and neighborhood socioeconomic factors influenced minority underuse of high-volume hospitals for colorectal cancer.
  
  
  METHODS
  The study was a retrospective, cross-sectional, population-based study.
  
  
  METHODS
  All hospitals in California from 1996 to 2006 were included.
  
  
  METHODS
  Patients with colorectal cancer diagnosed and treated in California between 1996 and 2006 were identified using California Cancer Registry data.
  
  
  METHODS
  Multivariable logistic regression models predicting high-volume hospital use were adjusted for age, sex, race, stage, comorbidities, insurance status, and neighborhood socioeconomic factors.
  
  
  RESULTS
  A total of 79,231 patients treated in 417 hospitals were included in the study. High-volume hospitals were independently associated with an 8% decrease in the hazard of death compared with other settings. A lower proportion of minorities used high-volume hospitals despite a higher proportion living nearby. Although insurance status and socioeconomic factors were independently associated with high-volume hospital use, only socioeconomic factors attenuated differences in high-volume hospital use of black and Hispanic patients compared with white patients.
  
  
  CONCLUSIONS
  The use of cross-sectional data and racial and ethnic misclassifications were limitations in this study.
  
  
  CONCLUSIONS
  Minority patients do not use high-volume hospitals despite improved outcomes and geographic access. Low socioeconomic status predicts low use of high-volume settings in select minority groups. Our results provide a roadmap for developing interventions to increase the use of and access to higher quality care and outcomes. Increasing minority use of high-volume hospitals may require community outreach programs and changes in physician referral practices.
authors: 1 Department of Surgery, Stanford University School of Medicine, Stanford, California 2 Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors: Lyen C
authors: LC
authors: Huang
authors: Thuy B
authors: TB
authors: Tran
authors: Yifei
authors: Y
authors: Ma
authors: Justine V
authors: JV
authors: Ngo
authors: Kim F
authors: KF
authors: Rhoads
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015179:Colorectal Neoplasms / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012189:Retrospective Studies; D012923:Social Class; D014195:Travel; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult