Multi-Institutional Study of Referral Patterns for Gynecologic Oncology Consultation.

Autor:	DeMari JA; Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC., Madeka I; Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC., Evans JK; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC., Bailey C; Division of Gynecological Oncology, Medical College of Georgia, Augusta, GA., Bartucci K; Division of Gynecologic Oncology, University of Missouri-Kansas City, Kansas City, MO., Bottsford-Miller J; Department of Gynecologic Oncology, Billings Clinic, Billings, MT., Bradford L; Division of Gynecologic Oncology, MaineHealth, Portland, ME., Burnett B; Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC., Kelly R; Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI., Rowland M; Division of Gynecologic Oncology, University of Missouri-Kansas City, Kansas City, MO., Wallbillich JJ; Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI., Shalowitz DI; West Michigan Cancer Center, Kalamazoo, MI.; Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2024 Sep; Vol. 20 (9), pp. 1198-1206. Date of Electronic Publication: 2024 May 22.
DOI:	10.1200/OP.23.00729
Abstrakt:	Purpose: Evaluation by a gynecologic oncologist (GO) is associated with improved clinical outcomes for patients with gynecologic cancers, yet little is known about health care factors that influence patients' referrals to GO. Methods: Medical records of 50 consecutive new patients seen in GO clinics at each of six referral centers across the United States were reviewed. Patient and disease characteristics were collected along with referral indication, evaluation and referral dates, diagnostic procedures, provider specialties, and zone improvement plan (ZIP) code of up to three referring providers per patient. The primary outcome was interval between first evaluation and referral. Univariate associations were evaluated with Chi-square and Wilcoxon rank-sum tests and multivariable associations with negative binomial regression models. Secondary outcome was prolonged time to GO referral, defined as greater than the 75th percentile. Logistic regression was used for multivariable modeling. Results: Three hundred patient records were analyzed. The median time from first health care encounter to referral was 15 days (IQR, 5-43). The mean distance from residence to GO was 39.8 miles (standard deviation, 53.8). Seventy-one percent of GO referrals were initiated by obstetrician-gynecologists, 9% by family physicians, and 6% internists. Presentation-to-referral interval was 76% shorter for patients evaluated by an emergency medicine clinician (exp(Beta), 0.24; 95% CI, 0.11 to 0.53; P < .001). Public insurance was associated with 1.47 times longer time to referral compared with private insurance (exp(Beta), 1.47; 95% CI, 1.05 to 2.04; P = .001). Residents of nonmetropolitan ZIP codes were less likely to have prolonged time to referral (odds ratio [OR], 0.288; P = .017). Distance from residence to GO (per 10 miles) increased the likelihood of prolonged time to referral (OR, 1.10; P = .010). Conclusion: Interventions are needed to improve recognition and referral of patients for gynecologic oncology evaluation. Community outreach and engagement with obstetrician-gynecologists should be prioritized to improve times to referral.
Databáze:	MEDLINE
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