Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers.

Autor:	Aminpour N; Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States., Phan V; Georgetown University School of Medicine, Washington, DC, United States., Wang H; MedStar Health Research Institute, Hyattsville, MD, United States., McDermott J; Department of Surgery, Stanford University, Stanford, CA, United States., Valentin M; Georgetown University School of Medicine, Washington, DC, United States., Mishra A; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States., DeLia D; Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States., Noel M; Department of Medicine, MedStar-Georgetown University Hospital, Washington, DC, United States., Al-Refaie W; Department of Surgery, Creighton University School of Medicine and CHI Health, Omaha, NE, United States. Electronic address: wal62554@creighton.edu.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Sep; Vol. 28 (9), pp. 1526-1532. Date of Electronic Publication: 2024 Jun 22.
DOI:	10.1016/j.gassur.2024.05.028
Abstrakt:	Background: For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. Methods: Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. Results: Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. Conclusion: Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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