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The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy.
Cancer 2018; 124(2):346-355C

Abstract

BACKGROUND

Diminished use and worse outcomes after immediate breast reconstruction (IBR) have been documented for Medicaid beneficiaries. However, to the authors' knowledge, the contribution of patient clustering at hospitals with a high percentage of Medicaid patients to these inequalities in IBR delivery is unknown.

METHODS

A cross-sectional analysis of patients undergoing IBR after mastectomy using the 2007 to 2011 Nationwide Inpatient Sample database was performed. Hospital Medicaid status was calculated as the percentage of all patients with Medicaid as a primary payer. Tertile groupings were generated to enable statistical analysis. Hierarchical regression models were used to investigate the link between Medicaid status and IBR use, outcomes, and costs. A subgroup of patients undergoing IBR for noninvasive cancer or those with increased genetic risk were used to study IBR use.

RESULTS

A total of 30,086 IBR cases in 1199 hospitals were analyzed. Hierarchical regression analysis demonstrated an association between high Medicaid burden hospitals and significantly decreased odds of IBR among patients with in situ disease and/or an elevated risk of cancer (odds ratio, 0.64; 95% confidence interval [95% CI], 0.507-0.806). Increasing age, obesity, being nonwhite, having more comorbid conditions, and having government insurance were found to be associated with diminished odds of IBR (P<.001 in all instances). In-hospital surgical and medical complication rates were comparable across the 3 strata of hospital Medicaid status. Log-adjusted costs of care were found to be positively associated with a higher hospital Medicaid burden status (coefficient of 0.038 [95% CI, 0.011-0.066] for medium Medicaid burden hospitals and coefficient of 0.053 [95% CI, 0.015-0.093] for high Medicaid burden hospitals).

CONCLUSIONS

High Medicaid burden hospital status is associated with an attenuation of IBR use and increased total inpatient costs. Structures of care such as hospital resources partially explain disparities in IBR delivery. Cancer 2018;124:346-55. © 2017 American Cancer Society.

Authors+Show Affiliations

Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.Baltimore, Maryland.Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29044475

Citation

Offodile, Anaeze C., et al. "The Site of Care Matters: an Examination of the Relationship Between High Medicaid Burden Hospitals and the Use, Cost, and Complications of Immediate Breast Reconstruction After Mastectomy." Cancer, vol. 124, no. 2, 2018, pp. 346-355.
Offodile AC, Muldoon LD, Gani F, et al. The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy. Cancer. 2018;124(2):346-355.
Offodile, A. C., Muldoon, L. D., Gani, F., Canner, J. K., & Jacobs, L. K. (2018). The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy. Cancer, 124(2), pp. 346-355. doi:10.1002/cncr.31046.
Offodile AC, et al. The Site of Care Matters: an Examination of the Relationship Between High Medicaid Burden Hospitals and the Use, Cost, and Complications of Immediate Breast Reconstruction After Mastectomy. Cancer. 2018 01 15;124(2):346-355. PubMed PMID: 29044475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy. AU - Offodile,Anaeze C,2nd AU - Muldoon,L Daniel, AU - Gani,Faiz, AU - Canner,Joseph K, AU - Jacobs,Lisa K, Y1 - 2017/10/17/ PY - 2017/07/17/received PY - 2017/08/26/revised PY - 2017/09/11/accepted PY - 2017/10/19/pubmed PY - 2019/6/14/medline PY - 2017/10/19/entrez KW - Medicaid KW - breast reconstruction KW - hospital characteristics KW - outcomes KW - surgical care use SP - 346 EP - 355 JF - Cancer JO - Cancer VL - 124 IS - 2 N2 - BACKGROUND: Diminished use and worse outcomes after immediate breast reconstruction (IBR) have been documented for Medicaid beneficiaries. However, to the authors' knowledge, the contribution of patient clustering at hospitals with a high percentage of Medicaid patients to these inequalities in IBR delivery is unknown. METHODS: A cross-sectional analysis of patients undergoing IBR after mastectomy using the 2007 to 2011 Nationwide Inpatient Sample database was performed. Hospital Medicaid status was calculated as the percentage of all patients with Medicaid as a primary payer. Tertile groupings were generated to enable statistical analysis. Hierarchical regression models were used to investigate the link between Medicaid status and IBR use, outcomes, and costs. A subgroup of patients undergoing IBR for noninvasive cancer or those with increased genetic risk were used to study IBR use. RESULTS: A total of 30,086 IBR cases in 1199 hospitals were analyzed. Hierarchical regression analysis demonstrated an association between high Medicaid burden hospitals and significantly decreased odds of IBR among patients with in situ disease and/or an elevated risk of cancer (odds ratio, 0.64; 95% confidence interval [95% CI], 0.507-0.806). Increasing age, obesity, being nonwhite, having more comorbid conditions, and having government insurance were found to be associated with diminished odds of IBR (P<.001 in all instances). In-hospital surgical and medical complication rates were comparable across the 3 strata of hospital Medicaid status. Log-adjusted costs of care were found to be positively associated with a higher hospital Medicaid burden status (coefficient of 0.038 [95% CI, 0.011-0.066] for medium Medicaid burden hospitals and coefficient of 0.053 [95% CI, 0.015-0.093] for high Medicaid burden hospitals). CONCLUSIONS: High Medicaid burden hospital status is associated with an attenuation of IBR use and increased total inpatient costs. Structures of care such as hospital resources partially explain disparities in IBR delivery. Cancer 2018;124:346-55. © 2017 American Cancer Society. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/29044475/The_site_of_care_matters:_An_examination_of_the_relationship_between_high_Medicaid_burden_hospitals_and_the_use_cost_and_complications_of_immediate_breast_reconstruction_after_mastectomy_ L2 - https://doi.org/10.1002/cncr.31046 DB - PRIME DP - Unbound Medicine ER -