title: Effects of Hospital Type and Distance on Lymph Node Assessment for Colon Cancer Among Metropolitan and Nonmetropolitan Patients in Appalachia.
abstract: We studied differences in access to large or accredited cancer programs as a possible explanation for geographic disparities in adherence to the national guideline on lymph node assessment for Stages I to III colon cancer. State cancer registries were linked with Medicare claims of patients diagnosed from 2006 to 2008 from Appalachian counties of four states. Metropolitan and nonmetropolitan patients differed on adherence, proximity to high-volume or accredited hospitals, and hospital type. We modeled effects of hospital type on adherence with ordinary least squares and instrumental variables (instrumenting for hospital type with relative distance). The evidence was strongest for improved adherence in high-volume hospitals for nonmetropolitan patients. We estimate that roughly 100 deaths might be prevented over 5 years among each year's incident cases if the nonmetropolitan disparity in hospital volume were eliminated nationally. We conclude that regionalization or targeting smaller hospitals would improve adherence in nonmetropolitan areas, but also argue for improving adherence generally.
authors.affiliation: Penn State University, University Park, PA, USA pamshort@psu.edu.
authors.forename: Pamela Farley
authors.initials: PF
authors.lastname: Short
authors.affiliation: Penn State University, University Park, PA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Moran
authors.affiliation: State University of New York at Albany, Albany, NY, USA.
authors.forename: Tse-Chuan
authors.initials: TC
authors.lastname: Yang
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.affiliation: Penn State University, Hershey, PA, USA.
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.affiliation: Penn State University, Hershey, PA, USA.
authors.forename: Heath B
authors.initials: HB
authors.lastname: Mackley
authors.affiliation: Penn State University, University Park, PA, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Matthews
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008198:Lymph Nodes / Q000002:abnormalities*; D008297:Male; D006278:Medicare; D012424:Rural Population; D014481:United States; D014505:Urban Population
keywords: clinical guidelines; colon cancer; geographic access; hospital volume; quality of care