Abstract

Objective

The association of continuity of care (COC) among providers and mortality risk for breast cancer patients with comorbidities is not sufficiently studied.

Design

A retrospective cohort study using the 2006–2014 Surveillance, Epidemiology and End Results (SEER)-Medicare data.

Participants

Newly diagnosed female breast cancer patients (n = 57,578) with comorbidities (hypertension, hyperlipidemia, and/or diabetes).

Methods

All-cause mortality was assessed annually for up to 5 years. COC was estimated using the Bice-Boxerman index, which included: 1) specialty COC capturing continuity of visits to the same provider type (Primary Care Physicians, Oncologists, and Other specialists) and 2) individual COC capturing continuous care to the same provider regardless of provider specialty. Cox proportional hazards models estimated the hazard ratio (HR) of all-cause mortality across quartile of the COC index.

Results

Mortality was positively associated with advanced tumor stages and number of comorbidities (p < 0.05). Patients with high specialty COC (4th vs. 1st quartile, HR 1.34, 95%CI 1.29–1.40) had higher risks of mortality compared with those with low specialty COC. However, patients with high individual COC (4th vs. 1st quartile, HR 0.53, 95%CI 0.51–0.54) had lower risks of mortality compared to those with low individual COC.

Conclusion

Receiving care from fewer providers is associated with lower mortality and from fewer types of provider is associated with higher mortality. The results might be confounded by uncontrolled factors and provoke the need for alternative patient care models that recognize the balance between appropriate subspecialties and minimizing the fragmentation of care within and across subspecialties.

中文翻译：

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患有心脏代谢合并症的乳腺癌患者的护理连续性与死亡风险的关系

摘要

客观的

提供者之间护理连续性 (COC) 与合并症乳腺癌患者死亡风险之间的关系尚未得到充分研究。

设计

使用 2006-2014 年监测、流行病学和最终结果 (SEER)-Medicare 数据的回顾性队列研究。

参与者

新诊断出患有合并症（高血压、高血脂和/或糖尿病）的女性乳腺癌患者 ( n  = 57,578)。

方法

每年评估全因死亡率长达 5 年。COC 是使用 Bice-Boxerman 指数估算的，其中包括：1) 专业 COC 捕获对同一提供者类型（初级保健医师、肿瘤学家和其他专家）就诊的连续性和 2) 个体 COC 捕获对同一提供者的持续护理，无论提供者专业。Cox 比例风险模型估计了 COC 指数四分位数全因死亡率的风险比 (HR)。

结果

死亡率与晚期肿瘤分期和合并症数量呈正相关（p  < 0.05）。与具有低专业 COC 的患者相比，具有高专业 COC 的患者（第 4 与第 1 个四分位数，HR 1.34，95%CI 1.29–1.40）具有更高的死亡风险。然而，与个体 COC 低的患者相比，个体 COC 高的患者（第 4 与第 1 个四分位数，HR 0.53，95%CI 0.51-0.54）的死亡风险较低。

结论

从较少的提供者那里接受护理与较低的死亡率相关，而从较少类型的提供者那里获得较高的死亡率。结果可能会受到不受控制的因素的混淆，并引发对替代患者护理模型的需求，该模型可以识别适当的亚专科之间的平衡，并最大限度地减少亚专科内部和跨专科的护理碎片化。