Rhoads KF, Patel MI, Ma Y, Schmidt LA. How do integrated health care systems address racial and ethnic disparities in colon cancer? J. Clin. Oncol. 2015;33(8):854–60. Available at: http://jco.ascopubs.org/content/33/8/854 [Accessed March 26, 2015].
Continuing the discussion from this earlier post (see: Just Read: Eliminating Racial Disparities in Medicare Advantage Plans), this study takes the previous one even farther – looking at the application of evidence based care and survival among people who have colon cancer.
A few things I learned while reading this one:
Definition of an integrated health system (IHS) – I didn’t know there was an official one (until now)
a fully integrated system is one where “care is provided by a single entity; whereby one organization is responsible for all services including delivery of care, payment and risk management
California has only one fully IHS
which is Kaiser Permanente 🙂 .
A few other relevant points (to me)
- “The proportion of Hispanic patients was distributed relatively evenly across settings, but more black patients were treated within the IHS (11.9% v 5.6%)”
- “The IHS treated a smaller proportion of patients with low SES (9.1% v 12.9%),” HOWEVER, this was taken into account: “To our knowledge, we are the first to compare process quality, outcome quality, and disparities between systems in a single investigation; we are also the first to use validated SES measures in the analysis.”
And the results
Minorities in these systems largely received higher rates of evidence-based care than those treated outside, and the racial gaps in receipt of quality care were generally smaller within the IHS than outside. PSM mortality models showed an overall survival advantage associated with care in the IHS for all stages of disease. There were no racial/ethnic disparities in survival noted within the IHS.
or in health services research-speak:
SM KM survival curves show better survival in the IHS setting (log-rank P .001). PSM Cox models show a protective association between the IHS and mortality for all three stages (HR, 0.87; 95% CI, 0.85 to 0.90). There was a similarly protective effect noted in each stage group.
These results were previously celebrated on the Kaiser Permanente Share site: Kaiser Permanente Share | Reducing Disparities in Colon Cancer Through Integrated Care, I’m just late to review the actual papers. I disagree with the title of said pronouncement, it should say “Eliminating” not “Reducing,” and I have made that adjustment in the title of this post.
Now that I’ve reviewed the paper I am even more impressed with the work. Eliminating disparities is what we came to medicine to do, and it shows that it can be done. There’s an editorial piece accompanying this one (Putting the Integration Into Integrated Health Care Systems) which discussed the fact that an “integrated health system” in and of itself is not enough. I agree, I’m glad I’m in this one, and appreciate the stimulation to learn more about why that is.