title: Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data.
abstract: Evidence suggests that high-volume facilities achieve better rectal cancer outcomes.
  
  
  
  Logistic regression was used to evaluate association of facility type with treatment after adjusting for patient demographics, stage, and comorbidities. SEER-Medicare beneficiaries who were diagnosed with stage II/III rectal adenocarcinoma at age ≥66 years from 2005 to 2009 and had Parts A/B Medicare coverage for ≥1 year prediagnosis and postdiagnosis plus a claim for cancer-directed surgery were included. Institutions were classified according to National Cancer Institute (NCI) designation, presence of residency program, or medical school affiliation.
  
  
  
  Two thousand three hundred subjects (average age = 75) met the criteria. Greater proportions of those treated at NCI-designated facilities received transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI)-pelvis (62.1 vs. 29.9 %), neoadjuvant chemotherapy (63.9 vs. 41.8 %), and neoadjuvant radiation (70.8 vs. 46.3 %), all p < 0.0001. On multivariate analysis, odds ratios (95 % confidence intervals) for receiving TRUS or MRI, neoadjuvant chemotherapy, or neoadjuvant radiation among beneficiaries treated at NCI-designated facilities were 3.51 (2.60-4.73), 2.32 (1.71-3.16), and 2.66 (1.93-3.67), respectively. Results by residency and medical school affiliation were similar in direction to NCI designation.
  
  
  
  Those treated at hospitals with an NCI designation, residency program, or medical school affiliation received more guideline-concordant care. Initiatives involving provider education and virtual tumor boards may improve care.
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA. mary-charlton@uiowa.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Hrabe
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA.
authors.forename: Kara B
authors.initials: KB
authors.lastname: Wright
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Schlichting
authors.affiliation: Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: McDowell
authors.affiliation: Mayo Clinic Cancer Center, Scottsdale, AZ, USA.
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Chi
authors.initials: C
authors.lastname: Lin
authors.affiliation: Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Cromwell
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare; D009017:Morbidity / Q000639:trends; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Guideline-concordant care; Medicare; Rectal cancer; Surveillance, Epidemiology, and End Results