دورية أكاديمية
أعرض في EDS

Access, Outcomes, and Costs Associated with Surgery for Malignancy Among People Experiencing Homelessness.

التفاصيل البيبلوغرافية
العنوان: Access, Outcomes, and Costs Associated with Surgery for Malignancy Among People Experiencing Homelessness.
المؤلفون: Silver CM; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Janczewski LM; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Royan R; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA., Chung JW; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA., Bentrem DJ; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Kanzaria HK; Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA., Stey AM; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Bilimoria KY; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA., Merkow RP; Department of Surgery, University of Chicago, Chicago, IL, USA. Ryan.Merkow@bsd.uchicago.edu.
المصدر: Annals of surgical oncology [Ann Surg Oncol] 2024 Mar; Vol. 31 (3), pp. 1468-1476. Date of Electronic Publication: 2023 Dec 10.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE
أسماء مطبوعة: Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-
مواضيع طبية MeSH: Ill-Housed Persons* , Neoplasms*, Humans ; Retrospective Studies ; Hospitalization ; Length of Stay
مستخلص: Background: Little is known about surgery for malignancy among people experiencing homelessness (PEH). Poor healthcare access may lead to delayed diagnosis and need for unplanned surgery. This study aimed to (1) characterize access to care among PEH, (2) evaluate postoperative outcomes, and (3) assess costs associated with surgery for malignancy among PEH.
Methods: This was a retrospective cohort study of patients in the Healthcare Cost and Utilization Project (HCUP) who underwent surgery in Florida, New York, or Massachusetts for gastrointestinal or lung cancer from 2016 to 2017. PEH were identified using HCUP's "Homeless" variable and ICD-10 code Z59. Multivariable regression models controlling patient and hospital variables evaluated associations between homelessness and postoperative morbidity, length of stay (LOS), 30-day readmission, and hospitalization costs.
Results: Of 67,034 patients at 566 hospitals, 98 (0.2%) were PEH. Most PEH (44.9%) underwent surgery for colorectal cancer. PEH more frequently underwent unplanned surgery than housed patients (65.3% vs 23.7%, odds ratio (OR) 5.17, 95% confidence interval (CI) 3.00-8.92) and less often were treated at cancer centers (66.0% vs 76.2%, p=0.02). Morbidity rates were similar between groups (20.4% vs 14.5%, p=0.10). However, PEH demonstrated higher odds of facility discharge (OR 5.89, 95% CI 3.50-9.78) and readmission (OR 1.81, 95% CI 1.07-3.05) as well as 67.7% longer adjusted LOS (95% CI 42.0-98.2%). Adjusted costs were 32.7% higher (95% CI 14.5-53.9%) among PEH.
Conclusions: PEH demonstrated increased odds of unplanned surgery, longer LOS, and increased costs. These results underscore a need for improved access to oncologic care for PEH.
(© 2023. Society of Surgical Oncology.)
References: The 2020 Annual Homeless Assessment Report (AHAR) to Congress. U.S. Department of Housing and Urban Development. Accessed 26 Aug 2022. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.
Criteria and Recordkeeping Requirements for Definition of Homelessness. Department of Housing and Urban Development. Accessed 11 Nov 2022. https://www.hudexchange.info/resource/1974/criteria-and-recordkeeping-requirements-for-definition-of-homeless/.
Castrucci B, Auerbach J. Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog. 2019;10(10.1377).
Abel MK, Lin JA, Wick EC. How can we improve surgical care of patients who are homeless? JAMA Surg. 2022. https://doi.org/10.1001/jamasurg.2022.2586 . (PMID: 10.1001/jamasurg.2022.258635793117)
Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529–40. https://doi.org/10.1016/s0140-6736(14)61132-6 . (PMID: 10.1016/s0140-6736(14)61132-6253905784520328)
Ku BS, Fields JM, Santana A, Wasserman D, Borman L, Scott KC. The urban homeless: super-users of the emergency department. Popul Health Manag. 2014;17(6):366–71. https://doi.org/10.1089/pop.2013.0118 . (PMID: 10.1089/pop.2013.011824865472)
Wadhera RK, Khatana SAM, Choi E, et al. Disparities in care and mortality among homeless adults hospitalized for cardiovascular conditions. JAMA Intern Med. 2020;180(3):357–66. https://doi.org/10.1001/jamainternmed.2019.6010 . (PMID: 10.1001/jamainternmed.2019.601031738826)
Cawley C, Kanzaria HK, Zevin B, Doran KM, Kushel M, Raven MC. Mortality among people experiencing homelessness in San Francisco during the COVID-19 pandemic. JAMA Netw Open. 2022;5(3):e221870. https://doi.org/10.1001/jamanetworkopen.2022.1870 . (PMID: 10.1001/jamanetworkopen.2022.1870352670308914573)
Cawley CL, Kanzaria HK, Kushel M, Raven MC, Zevin B. Mortality among people experiencing homelessness in San Francisco 2016–2018. J Gen Intern Med. 2021. https://doi.org/10.1007/s11606-021-06769-7 . (PMID: 10.1007/s11606-021-06769-7338353168904687)
Baggett TP, Hwang SW, O’Connell JJ, et al. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med. 2013;173(3):189–95. (PMID: 10.1001/jamainternmed.2013.1604233183023713619)
Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NA. Disparities in cancer incidence, stage, and mortality at Boston Health Care for the Homeless Program. Am J Prevent Med. 2015;49(5):694–702. (PMID: 10.1016/j.amepre.2015.03.038)
Gupta S, Tong L, Allison JE, et al. Screening for colorectal cancer in a safety-net health care system: access to care is critical and has implications for screening policy. Cancer Epidemiol Biomarkers Prevent. 2009;18(9):2373–9. (PMID: 10.1158/1055-9965.EPI-09-0344)
Asgary R. Cancer screening in the homeless population. Lancet Oncol. 2018;19(7):e344–50. https://doi.org/10.1016/s1470-2045(18)30200-6 . (PMID: 10.1016/s1470-2045(18)30200-630084381)
Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet. 2017;389(10077):1431–41. https://doi.org/10.1016/s0140-6736(17)30398-7 . (PMID: 10.1016/s0140-6736(17)30398-728402825)
HCUP Overview. Agency for Healthcare Research and Quality. Updated February 10, 2022. Accessed 2 Dec 2022. https://www.hcup-us.ahrq.gov/overview.jsp.
American Hospital Association Linkage Files. Agency for Healthcare Research and Quality. Updated November 14, 2019. Accessed 2 Dec 2022. https://www.hcup-us.ahrq.gov/db/state/ahalinkage/aha_linkage.jsp.
Hatef E, Rouhizadeh M, Tia I, et al. Assessing the availability of data on social and behavioral determinants in structured and unstructured electronic health records: a retrospective analysis of a multilevel health care system. JMIR Med Inform. 2019;7(3):e13802. (PMID: 10.2196/13802313762776696855)
Sullivan GA, Gely Y, Donaldson A, Rangel M, Gulack BC, Shah AN. Use of international classification of diseases, tenth revision, clinical modification Z codes to identify social determinants of health among surgical patients. JAMA Surg. 2022;157(8):735–7. https://doi.org/10.1001/jamasurg.2022.1211 . (PMID: 10.1001/jamasurg.2022.1211356750589178493)
ICD-10-CM official guidelines for coding and reporting: FY 2021. Centers for Medicare and Medicaid Services. Accessed 5 Dec 2022. https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf.
State Inpatient Database: Description of data elements. Healthcare Cost and Utilization Project. Accessed 23 Sept 2022. https://hcup-us.ahrq.gov/db/vars/siddistnote.jsp?var=homeless.
Wadhera RK, Choi E, Shen C, Yeh RW, Joynt Maddox KE. Trends, causes, and outcomes of hospitalizations for homeless individuals: a retrospective cohort study. Med Care. 2019;57(1):21–7. https://doi.org/10.1097/mlr.0000000000001015 . (PMID: 10.1097/mlr.0000000000001015304615847131970)
Valbuena VSM, Dualeh SHA, Kunnath N, Dimick JB, Ibrahim AM. Disparities in unplanned surgery amongst Medicare beneficiaries. Am J Surg. 2022. https://doi.org/10.1016/j.amjsurg.2022.08.018 . (PMID: 10.1016/j.amjsurg.2022.08.01836085082)
Zhang Y, Kunnath N, Dimmick J, Scott J, Diaz A, Ibrahim A. Social vulnerability and outcomes for access-sensitive surgical conditions among Medicare beneficiaries. Health Aff. 2022;41(5):671–9. https://doi.org/10.1377/hlthaff.2021.01615 . (PMID: 10.1377/hlthaff.2021.01615)
Merkow RP, Yang AD, Pavey E, et al. Comparison of hospitals affiliated with PPS-exempt cancer centers, other hospitals affiliated with NCI-designated cancer centers, and other hospitals that provide cancer care. JAMA Intern Med. 2019;179(8):1043–51. https://doi.org/10.1001/jamainternmed.2019.0914 . (PMID: 10.1001/jamainternmed.2019.0914312061426580440)
Patient safety indicators technical specifications. Accessed 9 Jan 2023. https://qualityindicators.ahrq.gov/measures/PSI_TechSpec.
Statistics BoL. CPI inflation calculator. Accessed 5 March 2023. https://data.bls.gov/cgi-bin/cpicalc.pl.
Market Basket Research and Information. Centers for Medicare and Medicaid Services. Updated December 7, 2022. Accessed March 7, 2023. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketResearch.
Stagg V. ELIXHAUSER: Stata module to calculate Elixhauser index of comorbidity. 2015.
Balla S, Alqahtani F, Alhajji M, Alkhouli M. Cardiovascular outcomes and rehospitalization rates in homeless patients admitted with acute myocardial infarction. Mayo Clinic Proceedings. 2020;95(4):660–8. https://doi.org/10.1016/j.mayocp.2020.01.013 . (PMID: 10.1016/j.mayocp.2020.01.01332200979)
Gabrielian S, Yuan AH, Andersen RM, Rubenstein LV, Gelberg L. VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Medical Care. 2014;52(5):454. (PMID: 10.1097/MLR.0000000000000112247145834714600)
Chau S, Chin M, Chang J, et al. Cancer risk behaviors and screening rates among homeless adults in Los Angeles County. Cancer Epidemiol Biomarkers Prevent. 2002;11(5):431–8.
Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons’ experiences of health- and social care: a systematic integrative review. Health Social Care Comm. 2020;28(1):1–11. https://doi.org/10.1111/hsc.12857 . (PMID: 10.1111/hsc.12857)
Corrigan P, Pickett S, Kraus D, Burks R, Schmidt A. Community-based participatory research examining the health care needs of African Americans who are homeless with mental illness. J Health Care Poor Underserved. 2015;26(1):119–33. https://doi.org/10.1353/hpu.2015.0018 . (PMID: 10.1353/hpu.2015.0018257027325388444)
Merkow RP, Chung JW, Paruch JL, Bentrem DJ, Bilimoria KY. Relationship between cancer center accreditation and performance on publicly reported quality measures. Ann Surg. 2014;259(6):1091–7. https://doi.org/10.1097/sla.0000000000000542 . (PMID: 10.1097/sla.000000000000054224509202)
Abel MK, Schwartz H, Lin JA, et al. Surgical care of patients experiencing homelessness: a scoping review using a phases of care conceptual framework. J Am Coll Surg. 2022;235(2):350–60. https://doi.org/10.1097/xcs.0000000000000214 . (PMID: 10.1097/xcs.0000000000000214358394149668043)
Flynn DE, Mao D, Yerkovich ST, et al. The impact of comorbidities on post-operative complications following colorectal cancer surgery. PLoS One. 2020;15(12):e0243995. https://doi.org/10.1371/journal.pone.0243995 . (PMID: 10.1371/journal.pone.0243995333622347757883)
Concannon KF, Thayer JH, Wu QV, Jenkins IC, Baik CS, Linden HM. Outcomes among homeless patients with non-small-cell lung cancer: a county hospital experience. JCO Oncol Pract. 2020;16(9):e1004–14. https://doi.org/10.1200/jop.19.00694 . (PMID: 10.1200/jop.19.00694325257537489482)
Nathan H, Yin H, Wong SL. Postoperative complications and long-term survival after complex cancer resection. Ann Surg Oncol. 2017;24:638–44. (PMID: 10.1245/s10434-016-5569-527619939)
Connor E, Newlin E, Vargas R, AlHilli M. Non-home discharge is associated with longer interval to adjuvant chemotherapy and increased 90-day mortality in women undergoing surgery for epithelial ovarian cancer. Gynecol Oncol. 2018;149(3):624. (PMID: 10.1016/j.ygyno.2018.03.021)
Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998;338(24):1734–40. https://doi.org/10.1056/nejm199806113382406 . (PMID: 10.1056/nejm1998061133824069624194)
Rollings KA, Kunnath N, Ryus CR, Janke AT, Ibrahim AM. Association of coded housing instability and hospitalization in the US. JAMA Network Open. 2022;5(11):e2241951. https://doi.org/10.1001/jamanetworkopen.2022.41951 . (PMID: 10.1001/jamanetworkopen.2022.41951363744989664259)
Mensing LA, Kappelle LJ, Koffijberg H, Ruigrok YM. Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study. BMJ Open. 2023;13(1):e064445. https://doi.org/10.1136/bmjopen-2022-064445 . (PMID: 10.1136/bmjopen-2022-064445365966379815001)
Doran KM, Ragins KT, Gross CP, Zerger S. Medical respite programs for homeless patients: a systematic review. J Health Care Poor Underserved. 2013;24(2):499–524. https://doi.org/10.1353/hpu.2013.0053 . (PMID: 10.1353/hpu.2013.005323728025)
Doran KM, Boyer AP, Raven MC. Health care for people experiencing homelessness—What outcomes matter? JAMA Network Open. 2021;4(3):e213837–e213837. https://doi.org/10.1001/jamanetworkopen.2021.3837 . (PMID: 10.1001/jamanetworkopen.2021.383733764419)
Blumenthal D, Abrams MK. Tailoring complex care management for high-need, high-cost patients. JAMA. 2016;316(16):1657–8. https://doi.org/10.1001/jama.2016.12388 . (PMID: 10.1001/jama.2016.1238827669168)
Lipson D. Medicaid's role in improving the social determinants of health: Opportunities for states. Accessed 3 March 2023. https://www.nasi.org/wp-content/uploads/2017/06/Opportunities-for-States_web.pdf.
Costello A. Opportunies in Medicaid and CHIP to address social determinants of health (SDOH). Accessed 3 March 2023. https://www.medicaid.gov/federal-policy-guidance/downloads/sho21001.pdf.
Truong HP, Luke AA, Hammond G, Wadhera RK, Reidhead M, Joynt Maddox KE. Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016–2017. Med Care. 2020;58(12):1037–43. https://doi.org/10.1097/mlr.0000000000001418 . (PMID: 10.1097/mlr.0000000000001418329254537666017)
Silver CM, Thomas AC, Reddy S, et al. Injury patterns and hospital admission after trauma among people experiencing homelessness. JAMA Netw Open. 2023;6(6):e2320862. https://doi.org/10.1001/jamanetworkopen.2023.20862 . (PMID: 10.1001/jamanetworkopen.2023.208623738295510311388)
Koch CG, Li L, Hixson E, Tang A, Phillips S, Henderson JM. What are the real rates of postoperative complications: elucidating inconsistencies between administrative and clinical data sources. J Am Coll Surg. 2012;214(5):798–805. https://doi.org/10.1016/j.jamcollsurg.2011.12.037 . (PMID: 10.1016/j.jamcollsurg.2011.12.03722421260)
Willison C, Unwala N, Singer PM, Creedon TB, Mullin B, Cook BL. Persistent disparities: trends in rates of sheltered homelessness across demographic subgroups in the USA. J Racial Ethn Health Disparities. 2023. https://doi.org/10.1007/s40615-023-01521-9 . (PMID: 10.1007/s40615-023-01521-9367952919933811)
Casey JA, Pollak J, Glymour MM, Mayeda ER, Hirsch AG, Schwartz BS. Measures of SES for electronic health record-based research. Am J Prev Med. 2018;54(3):430–9. https://doi.org/10.1016/j.amepre.2017.10.004 . (PMID: 10.1016/j.amepre.2017.10.00429241724)
معلومات مُعتمدة: T32 CA247801 United States CA NCI NIH HHS; K23HL157832-01 United States HL NHLBI NIH HHS; T32CA247801 United States CA NCI NIH HHS
فهرسة مساهمة: Keywords: Healthcare costs; Homelessness; Length of stay; Malignancy; Outcomes; Surgery
تواريخ الأحداث: Date Created: 20231210 Date Completed: 20240208 Latest Revision: 20240425
رمز التحديث: 20240425
DOI: 10.1245/s10434-023-14713-8
PMID: 38071712
قاعدة البيانات: MEDLINE
الوصف
تدمد:1534-4681
DOI:10.1245/s10434-023-14713-8