哥伦比亚医疗分散与结直肠癌患者存活率的关系

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues Pub Date : 2024-01-18 DOI:10.1016/j.vhri.2023.12.003

Andrés Felipe Patiño-Benavidez MD , Giancarlo Buitrago MD, MSc, PhD , Nicolás Rozo-Agudelo MD , Laura Estefanía Saldaña-Espinel MD , Óscar Andrés Gamboa-Garay MD , Javier Eslava-Schmalbach MD, MSc, PhD , Carlos Bonilla-González MD , Óscar Guevara-Cruz MD , Rubén Ernesto Caycedo MD , Edgar Germán Junca MD , Ricardo Sánchez-Pedraza MD, MSc

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引用次数: 0

摘要

本研究旨在确定哥伦比亚结直肠癌患者的医疗保健碎片化与存活率之间的关系。方法利用行政数据库开展了一项回顾性队列研究，通过电子算法根据代码识别结直肠癌患者。患者登记时间为 2013 年 1 月 1 日至 2016 年 12 月 31 日。暴露变量是分散性，根据患者确诊后第一年内接受治疗的不同医疗机构数量来衡量。使用倾向评分进行匹配以控制混杂因素，并计算匹配样本暴露于较高分散性的危险比。结果共发现 5036 名结直肠癌患者，其中 2525 名（49.88%）为女性。总样本中联网医疗机构的平均数量为 5.71 家（标清 1.98 家）。分散程度较高的四分位组患者死亡率最高，为每 100 名患者 35.67 例（95% CI 33.63-38.06）。将破碎率较高的四分位数与较低的四分位数进行比较，得出的发病率比为 1.23 (95% CI 1.04-1.45; P = .02)。在 5036 名患者中，有 422 人（8.38%）被列为暴露人群（破碎率较高）。结论暴露于高度分散的医疗网络会降低哥伦比亚结直肠癌患者的总体 4 年生存率。

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Association of Healthcare Fragmentation and the Survival of Patients with Colorectal Cancer in Colombia

Objectives

The objective of this study was to identify the association between healthcare fragmentation and survival for patients with colorectal cancer in Colombia.

Methods

A retrospective cohort study was performed using administrative databases, with an electronic algorithm to identify patients with colorectal cancer based on codes. The patients were enrolled between January 1, 2013, and December 31, 2016. The exposure variable was fragmentation, which was measured based on the number of different healthcare institutions that treated a patient during the first year after diagnosis. Matching was performed using propensity scores to control for confounding, and the hazard ratio for exposure to higher fragmentation was calculated for the matched sample.

Results

A total of 5036 patients with colorectal cancer were identified, 2525 (49.88%) of whom were women. The mean number of network healthcare institutions for the total sample was 5.71 (SD 1.98). The patients in the quartile with higher fragmentation had the highest mortality rate, 35.67 (95% CI 33.63-38.06) per 100 patients. The comparison of higher and lower quartiles of fragmentation resulted in an incidence rate ratio of 1.23 (95% CI 1.04-1.45; P = .02). Of the 5036 patients, 422 (8.38%) were classified as the exposed cohort (higher fragmentation). The total matched sample consisted of 844 subjects, and an HR of 1.26 (95%CI; 1.05-1.51) was estimated.