背景:初级保健(PC)对于总体健康和合并症的管理至关重要。反过来,无法充分使用PC的患者可能面临医疗保健差异。我们试图描述已建立的PC对消化道癌症手术患者术后结局的影响。
方法:诊断为肝胆疾病的Medicare受益人,胰腺,2005年至2019年之间的结直肠癌在监测中被发现,流行病学,以及最终结果计划和医疗保险相关数据库。确定了在手术前1年内没有与PC接触的人。术后教科书结果(TO)被定义为没有并发症,没有长时间住院,90天内没有再入院,没有死亡率。
结果:在63,177名患者中,50,974(80.7%)在手术前至少进行了一次PC访问。已建立PC的患者更有可能达到TO(比值比[OR],1.14;95%置信区间[CI],1.09-1.19),并发症的几率较低(OR,0.85;95%CI,0.72-0.89),延长住院时间(或,0.86;95%CI,0.81-0.94),90天再入院(或,0.94;95%CI,0.90-0.99),和90天死亡率(OR,0.87;95%CI,0.79-0.96)。此外,PC确定的患者的指数费用下降4.1%,1年费用下降5.2%.值得注意的是,在手术前一年进行过1至5次PC访问的患者的TO几率提高(或,1.21;95%CI,1.16-1.27),而就诊次数超过10次的个体术后TO的几率较低(或,0.91;95%CI,0.84-0.98)。
结论:大多数患有消化道癌症的医疗保险受益人在手术前一年内已经建立了PC。成熟的PC与获得理想结果的可能性更高,成本更低。相比之下,超过10个PC预约的患者,这可能是总体合并症负担的替代品,术后结局没有改善。
BACKGROUND: Primary care (PC) is essential to overall wellness and management of comorbidities. In turn, patients without adequate access to PC may face healthcare disparities. We sought to characterize the impact of established PC on postoperative outcomes among patients undergoing a surgical procedure for a digestive tract cancer.
METHODS: Medicare beneficiaries with a diagnosis of hepatobiliary, pancreas, and colorectal cancer between 2005 and 2019 were identified within the Surveillance, Epidemiology, and End Results program and Medicare-linked database. Individuals who did versus did not have PC encounters within 1-year before surgery were identified. A postoperative textbook outcome (TO) was defined as the absence of complications, no prolonged hospital stay, no readmission within 90 days, and no mortality.
RESULTS: Among 63,177 patients, 50,974 (80.7%) had at least one established PC visit before surgery. Patients with established PC were more likely to achieve TO (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19) with lower odds for complications (OR, 0.85; 95% CI, 0.72-0.89), extended hospital stay (OR, 0.86; 95% CI, 0.81-0.94), 90-day readmission (OR, 0.94; 95% CI, 0.90-0.99), and 90-day mortality (OR, 0.87; 95% CI, 0.79-0.96). In addition, patients with established PC had a 4.1% decrease in index costs and a 5.2% decrease in 1-year costs. Notably, patients who had one to five visits with their PC in the year before surgery had improved odds of TO (OR, 1.21; 95% CI, 1.16-1.27), whereas individuals with more than 10 visits had lower odds of a postoperative TO (OR, 0.91; 95% CI, 0.84-0.98).
CONCLUSIONS: Most Medicare beneficiaries with digestive tract cancer had established PC within the year before their surgery. Established PC was associated with a higher probability of achieving ideal outcomes and lower costs. In contrast, patients with more than 10 PC appointments, which was likely a surrogate of overall comorbidity burden, experienced no improvement in postoperative outcomes.