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Transferred and Delayed Care of Patients with Colorectal Cancer in a Safety-Net Hospital System—Manifestations of a Distressed Healthcare System

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ABSTRACT

Background

Safety-net hospital systems provide care to a large proportion of United States’ under- and uninsured population. We have witnessed delayed colorectal cancer (CRC) care in this population and sought to identify demographic and systemic differences in these patients compared to those in an insured health-care system.

Design, Patients, and Approach/Measurements

We collected demographic, socioeconomic, and clinical data from 2005–2007 on all patients with CRC seen at Parkland Health and Hospital System (PHHS), a safety-net health system and at Presbyterian Hospital Dallas System (Presbyterian), a community health system, and compared characteristics among the two health-care systems. Variables associated with advanced stage were identified with multivariate logistic regression analysis and odds ratios were calculated.

Results

Three hundred and eighteen patients at PHHS and 397 patients at Presbyterian with CRC were identified. An overwhelming majority (75 %) of patients seen at the safety-net were diagnosed after being seen in the emergency department or at an outside facility. These patients had a higher percentage of stage 4 disease compared to the community. Patients within the safety-net with Medicare/private insurance had lower rates of advanced disease than uninsured patients (25 % vs. 68 %, p < 0.001). Insurance status and physician encounter resulting in diagnosis were independent predictors of disease stage at diagnosis.

Conclusions

A large proportion of patients seen in the safety-net health system were transferred from outside systems after diagnosis, thus leading to delayed care. This delay in care drove advanced stage at diagnosis. The data point to a pervasive and systematic issue in patients with CRC and have fundamental health policy implications for population-based CRC screening.

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Acknowledgments

The authors would like to thank the staff at the Parkland Health and Hospital System and Presbyterian Health System tumor registries for their assistance. We thank Drs. Chul Ahn and Lei Xuan for statistical assistance. We wish to specifically thank Dr. Ron Anderson for insightful comments and suggestions.

This work was supported the NIH (CTSA grant UL1 RR024982-02 and by NIH training grant T32DK07745 (to JS).

Conflict of Interest

Disclosure information: The authors certify that we have no financial arrangements (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, major honoraria, etc.) with a company whose product figures prominently in this manuscript or with a company making a competing product. To the best of our knowledge, no conflict of interest, financial or other, exists.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8887, USA

    Jessica P. Shah MD & Don C. Rockey MD

  2. Performance Improvement and Patient Safety, Parkland Health and Hospital System, Dallas, TX, USA

    Marisa Valdes BSN

Authors
  1. Jessica P. Shah MD
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  2. Marisa Valdes BSN
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  3. Don C. Rockey MD
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Correspondence to Don C. Rockey MD.

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Shah, J.P., Valdes, M. & Rockey, D.C. Transferred and Delayed Care of Patients with Colorectal Cancer in a Safety-Net Hospital System—Manifestations of a Distressed Healthcare System. J GEN INTERN MED 27, 1142–1149 (2012). https://doi.org/10.1007/s11606-012-2040-6

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  • DOI: https://doi.org/10.1007/s11606-012-2040-6

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