Organizational Factors Affect Safety‐Net Hospitals' Breast Cancer Treatment Rates. (14th November 2016) - Bickell, Nina A.
Abstract : Objective: To identify key organizational approaches associated with underuse of breast cancer care. Setting: Nine New York City area safety‐net hospitals. Study Design: Mixed qualitative–quantitative, cross‐sectional cohort. Methods: We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions, " calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors' impact on underuse. Principal Findings: Underuse varied by hospital (8–29 percent). QCA found lower underuse sites designated individuals to track and follow‐up no‐shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient‐centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow‐up had low underuse rates (RR = 0.28; 0.08–0.95); individual patient characteristics were not significant. Conclusions: At safety‐net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow‐up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery.