Colon Cancer as an Ambulatory Care Sensitive Condition

Ambulatory Care Sensitive Conditions (ACSC) are conditions usually measured from hospital discharge data where insufficient provision of ambulatory care may affect the probability of hospitalization--or the severity of the disease at hospitalization. GIS analyses provide stakeholders with visually informative analyses that identify populations where additional resources are needed. If colorectal cancer (CRC) was added to the list of ACSCs, it could identify hospitals and communities where CRC hospitalizations are more common and where intervention may be feasible in collaboration with health systems, state agencies or state cancer coalitions.

The analysis used hospital data from the Pennsylvania Health Care Cost Containment Council (PHC4) for patients admitted to hospitals in 2006. Only the first hospitalization within the year was included for any individual. Disease Staging was used to identify patient cohorts as well as to refine definitions of colon cancer by severity of illness stage. Disease Staging is a clinically based hospital patient classification system developed in the 1970s under the auspices of the National Center for Health Center Research. It used ICD-9-CM codes found on claims data to classify hospital admissions, and differentiated between cases of CRC at stages I-IV. Demographic data for 2000 the Census were used to calculate adjusted rates by county. Geographic information systems (GIS) were utilized to identify variation between counties. Hospitals with the larger proportion of later stage cases were depicted with GIS.

There were a total of 9,622 individuals over 18 years of age with a primary diagnosis of colon cancer admitted in 2006. 48.4% of colon cancer admissions were for later stages, where the cancer had spread locally or metastasized to extra-colonic sites. Younger age groups (18-44) (60.9%) and the uninsured (58.3%) had the highest proportion of later stage hospitalizations. There was wide variation in the age-sex adjusted rates of these cancer admissions, and we observed high rates of later stage hospitalizations in areas where there were few hospital resources.

This study presents a novel approach to using health services data. Geographic and hospital-based analyses identify targets for community planning and policy development. Hospitals with high volumes of colon cancer cases may be institutions with interest and expertise to serve as advocates for colorectal screening initiatives. Employing colorectal cancer as an ACSC at the hospital or county level can provoke policy makers and managers to examine the links in the continuum of care to find gaps and weaknesses that merit attention.