title: Preoperative experience for public hospital patients with gynecologic cancer: Do structural barriers widen the gap?
abstract: BACKGROUND
  Widespread disparities in care have been documented in women with gynecologic cancer in the United States. This study was designed to determine whether structural barriers to optimal care were present during the preoperative period for patients with gynecologic cancer.
  
  
  METHODS
  A retrospective review was conducted for patients undergoing surgery for a gynecologic malignancy at a public hospital or a private hospital staffed by the same team of gynecologic oncologists between July 1, 2013 and July 1, 2014.
  
  
  RESULTS
  Two hundred fifty-seven cases were included for analysis (public hospital, 69; private hospital, 188). Patients treated at the private hospital were older (58 vs 52 years; P = .004) and had similar medical comorbidities (median Charlson comorbidity index at both hospitals, 6) but required fewer hospital visits in preparation for surgery (2 vs 4; P < .001). Public hospital patients had a longer wait time from the diagnosis of disease to surgery (63 vs 34 days; P < .001). According to a multiple linear regression model, the public hospital setting was associated with a longer interval from diagnosis to surgery with adjustments for the insurance status, age at diagnosis, cancer stage, and number of preoperative hospital visits (P < .001).
  
  
  CONCLUSIONS
  Patients at the public hospital were subject to a greater number of preoperative visits and had to wait longer for surgery than patients at the private hospital. Attempts to reduce health care disparities should focus on improving efficiency in health care delivery systems once contact has been established.
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Frey
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Haley A
authors.initials: HA
authors.lastname: Moss
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Musa
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Linda
authors.initials: L
authors.lastname: Rolnitzky
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Gizelka
authors.initials: G
authors.lastname: David-West
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Chern
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Boyd
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: John P
authors.initials: JP
authors.lastname: Curtin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000601:surgery*; D054625:Healthcare Disparities; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D012189:Retrospective Studies; D061665:Time-to-Treatment
keywords: gynecologic neoplasms; gynecologic surgery; health care disparities; health care inequalities; public hospitals