University of Michigan, Ann Arbor, MI
Sarah T. Hawley , Scott E. Regenbogen , Christine Marie Veenstra , Arden M. Morris
Background: Care coordination is an essential component of effective, patient-centered cancer care. Yet little is known about the impact of patient reported care coordination on clinical outcomes, such as postoperative complications following high risk colorectal cancer surgery. Methods: In 2011-13, we surveyed Stage III colorectal cancer patients from Detroit and Georgia SEER registries 4-12 months after diagnosis. The primary outcome was self-report of a postoperative complication. We adapted a validated 6-item scale to assess perceived coordination across the overall continuum of cancer care (range 6-30). We used a separate 7-item scale to assess perceived care coordination specifically pre- and postoperatively (range 7-35). We compared the association between postoperative complications and overall and pre- /postoperative care coordination with chi-square tests. We assessed associations between complications and coordination in each phase of care in separate models, using logistic regression to control for age, race, education and insurance. Results: Among 1465 patients who returned surveys (RR = 66%), 23.1% reported a postoperative complication. Most respondents perceived their care coordination to be good overall (mean: 25.9, SD: 3.7), as well as pre- (mean: 29.5, SD 4.6) and postoperatively (mean: 30, SD 4.3). Older, minority and those with more comorbidities significantly more often perceived poor care coordination (P < 0.001). In adjusted analyses, postoperative complications were inversely associated with perceptions of good care coordination overall (OR: 0.72, 95% CI: 0.59-0.97) and with better pre- and post-operative coordination (OR = 0.96, 95% CI = 0.93-.98; OR = 0.93, 95% CI = 0.91-0.97, respectively). Conclusions: Similar to other large studies, complications in this sample were common after colorectal cancer surgery. Reported care coordination was good for most patients, but less so for certain vulnerable subgroups. Better care coordination was associated with lower rates of surgical complications. Such findings indicate that better care coordination may lead to better clinical outcomes, however further work to confirm and expand these results is needed.
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