Online Program

283199
Are outcomes worse in low volume and non-teaching hospitals for female breast cancer patients?


Sunday, November 3, 2013

Margaret M. Byrne, PhD, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Stacey L. Tannenbaum, PhD, RD, LD/N, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Tulay Koru-Sengul, MHS, PhD, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Feng Miao, MSc, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
Introduction: Disparities in survival associated with receiving treatment at low volume and/or non-teaching hospitals have been found in some cancers. We explored whether survival in women with breast cancer was related to the treating hospital's characteristics. Methods: Florida Cancer Data System Registry (1996-2007), Agency for Health Care Administration, and US Census data were linked (N=127,754). High volume facilities (HVF), as compared to low volume (LVF), were defined as facilities treating ≥1% of the sample; and teaching (TF) vs. non-teaching facilities (NTF) were identified by the 2005 Association of American Medical Colleges. We calculated descriptive statistics and ran Cox regression models exploring the association of hospital type and survival. Results: Overall, 41% of women were treated in HVF and 10% in TF. The distribution of race and ethnicity differed between NTF (Whites 91%, Blacks 8%; non-Hispanic 91%, Hispanic 9%) and TF (Whites 84%, Blacks 15%; non-Hispanic 82%, Hispanic 18%); as did the distribution of socioeconomic status (SES) ┬ĘC from lowest to highest quartiles in NTF (10, 29, 39, 22%) and TF (20, 32, 30, 19%). No differences in demographics between HVF and LVF. Cox regression adjusting for sociodemographic, clinical, and treatment characteristics showed that NTF were significantly associated with worse outcomes, (Hazard ratio [HR] 1.13; [95%Confidence Interval 1.03-1.24]), p=0.013; but LVF were not, (HR 1.0; [0.90-1.10]). Conclusion: TF are caring for more minority and lower SES patients. However, controlling for comorbidities, survival is better for patients treated at TF.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Epidemiology
Provision of health care to the public

Learning Objectives:
Explain the difference between low and high volume hospitals, and teaching and non-teaching hospitals. Describe the differences in the populations that are being treated for breast cancer in teaching vs. non-teaching hospitals. Discuss reasons why differences in survival might be occurring in teaching vs. non-teaching hospitals.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author because I have been the principal and co-principal investigator of a multiple federally funded grants focusing on the epidemiology of cancer in a population-based sample in the state of Florida. I have worked with hospital volume and teaching disparities in breast and lung cancers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.