Can Integrated Health Care Eliminate Racial Disparities in Cancer Survival?

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Racial disparities in colorectal cancer survival might be eliminated by integrated and “equitable, evidence-based care.”
Racial disparities in colorectal cancer survival might be eliminated by integrated and “equitable, evidence-based care.”

Racial disparities in colorectal cancer survival might be eliminated by integrated and “equitable, evidence-based care,” the lead author of a new study told Cancer Therapy Advisor. That's good news for the promise of the Accountable Care Organization (ACO) model championed in the Affordable Care Act.

For patients diagnosed with colorectal cancer, receiving care in an integrated health care system increases rates of evidence-based treatment, improves patient outcomes, and eliminates racial survival disparities, according to a new study published in the Journal of Clinical Oncology.1

The study “is one of the first to use hospital-level characteristics to predict the delivery of evidence-based care and then to link that to colon cancer survival overall and by race,” said lead author Kim F. Rhoads, MD, MPH, FACS, an assistant professor of surgery and director of the Community Partnership Program at the Stanford Cancer Institute in Stanford, CA.

The study team retrospectively analyzed more than 30,000 records from the California Cancer Registry for patients diagnosed with colorectal cancer between 2001 and 2006 and compared rates of evidence-based care (compliance with National Comprehensive Cancer Network [NCCN] guidelines) in the Kaiser Permanente integrated health care system.

Dr. Rhoads was quick to point out that because the data was retrospective, it identifies associations as opposed to proving causation. Those associations, however, are strong and compelling.

“We can't be sure that health care systems cause disparities, but our work raises the possibility that we can reduce these differences by providing equitable, evidence-based care.”

Successful treatment of colon cancer “requires treatment from multiple providers, potentially at multiple facilities and patients can easily get lost in the process of clinical hand-offs,” Dr. Rhoads said.

“Our work suggests that hospitals that are part of California's only fully integrated health care system deliver each step in evidence-based colon cancer care at higher rates than hospitals outside that system.”

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The researchers also found that patients with stage I to III colon cancer who were treated in that system had a survival advantage over patients elsewhere.

“The results suggest that integrated systems may be better able to coordinate colon cancer care across multiple disciplines as compared to other types of hospitals or systems, and this may drive better outcomes,” Dr. Rhoads said.

That's good news for the ACOs championed in the Affordable Care Act. “Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform,” the study authors concluded.1

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