title: Organizational Factors Affect Safety-Net Hospitals' Breast Cancer Treatment Rates.
abstract: To identify key organizational approaches associated with underuse of breast cancer care.
  
  
  
  Nine New York City area safety-net hospitals.
  
  
  
  Mixed qualitative-quantitative, cross-sectional cohort.
  
  
  
  We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions," calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors' impact on underuse.
  
  
  
  Underuse varied by hospital (8-29 percent). QCA found lower underuse sites designated individuals to track and follow-up no-shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient-centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow-up had low underuse rates (RR = 0.28; 0.08-0.95); individual patient characteristics were not significant.
  
  
  
  At safety-net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow-up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery.
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
authors.affiliation: Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.
authors.forename: Alexandra DeNardis
authors.initials: AD
authors.lastname: Moss
authors.affiliation: Department of Surgery, Jacobi Hospital Center, Bronx, NY.
authors.forename: Maria
authors.initials: M
authors.lastname: Castaldi
authors.affiliation: Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY.
authors.forename: Ajay
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Surgery, Lutheran Medical Center, Brooklyn, NY.
authors.forename: Alan
authors.initials: A
authors.lastname: Sickles
authors.affiliation: Department of Surgery, Brooklyn Hospital Center, Brooklyn, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Pappas
authors.affiliation: Department of Surgery, Kings County Hospital Center, Brooklyn, NY.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Lewis
authors.affiliation: Department of Surgery, Queens Hospital Center, Jamaica, NY.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kemeny
authors.affiliation: Department of Surgery, Elmhurst Hospital Center, Elmhurst, NY.
authors.forename: Shalini
authors.initials: S
authors.lastname: Arora
authors.affiliation: Division of Hematology/Oncology, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Lori
authors.initials: L
authors.lastname: Schleicher
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Franco
authors.affiliation: Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.
authors.forename: Ann Scheck
authors.identifier: 0000-0001-9107-5419
authors.initials: AS
authors.lastname: McAlearney
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D003266:Continuity of Patient Care / Q000458:organization & administration; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009519:New York City; D015279:Organizational Culture; D018802:Patient-Centered Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D064876:Safety-net Providers / Q000458:organization & administration* / Q000706:statistics & numerical data*
keywords: Cancer care quality; breast cancer; coordination; organizational approaches; qualitative comparative analysis