期刊
JCO ONCOLOGY PRACTICE
卷 17, 期 5, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1200/OP.20.01089
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资金
- National Cancer Institute of the National Institutes of Health [R01 CA185623, R01 CA133264, R01CA100598, P01 CA151135, K22 CA138563, P30 CA072720, P30 CA016056]
- American Cancer Society [RSGT-07-291-01-CPHPS]
- Breast Cancer Foundation [POP131006]
- US Army Medical Research and Material Command [DAMD-17-01-1-0334]
- Breast Cancer Research Foundation (Ambrosone, Hong)
- Buckingham Foundation
- Health Policy Research Scholars Program
- Robert Wood Johnson Foundation
- New Jersey State Cancer Registry
- Cancer Epidemiology Services
- New Jersey Department of Health
- Surveillance, Epidemiology and End Results(SEER)
- National Cancer Institute [HHSN261201300021, N01-PC-2013-00021]
- National Program of Cancer Registries (NPCR)
- Centers for Disease Control and Prevention [NU5U58DP006279-02-00]
- State of New Jersey
- Rutgers Cancer Institute of New Jersey
Black women with comorbidities and breast cancer often receive primary care and surgical care in different health systems, indicating care fragmentation. Strategies for care coordination and healthcare delivery across various health systems and practice settings are necessary for achieving health equity.
PURPOSE Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation.MATERIALS AND METHODS We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation.RESULTS Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer-accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (P > .05).CONCLUSION The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.
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