Colorectal cancer surgery outcomes for vulnerable patients in safety-net versus non-safety-net hospitals

J Health Care Poor Underserved. 2013 May;24(2):718-29. doi: 10.1353/hpu.2013.0062.

Abstract

Extensive research documents disparities in health outcomes for vulnerable populations. Safety-net hospitals-those that serve a greater proportion of vulnerable patients with Medicaid or no insurance-may yield better outcomes for these vulnerable patients because of their expertise with this population. National Inpatient Sample data from 2005-2007 show that predicted rates of complications following colorectal cancer surgery are approximately 20% lower for vulnerable patients in safety-net than in non-safety-net hospitals (0.273 versus 0.340; 95% CI for the difference: -0.11, -0.001). Differences by safety-net status for Medicare and privately-insured patients were smaller and not statistically significant. The lower complication rates are not due to earlier discharge, as vulnerable patients had significantly longer stays at safety-net hospitals (1.79 days; 95% CI 0.13, 3.40). Additional research is needed to determine whether improvement in post-operative outcomes is due to the expertise of safety-net hospitals in caring for patients with Medicaid or no insurance.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colorectal Neoplasms / surgery*
  • Comorbidity
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Medicare / statistics & numerical data
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Safety-net Providers / statistics & numerical data*
  • Socioeconomic Factors
  • Treatment Outcome
  • United States
  • Vulnerable Populations / statistics & numerical data*