Search

OBJECTIVE: To assess the impact of a granular measure of socioeconomic deprivation on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway. SUMMARY BACKGROUND DATA: Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for pancreatic adenocarcinoma. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables. METHODS: We conducted a retrospective cohort study of 1,552 pancreatic adenocarcinoma patients between 2008 and 2015. Patients were stratified using the Area Deprivation Index, a validated dataset that ranks census block groups based on socioeconomic deprivation (SED). Multivariable models were used in the curative surgery cohort to predict the impact of SED on 1) grade 3/4 Clavien-Dindo complications, 2) initiation of adjuvant therapy 3) completion of adjuvant therapy, and 4) overall survival RESULTS: Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival. CONCLUSIONS: While nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.

Background Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Study Design Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. Results For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Conclusions Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients.

RESULTS: The cohort contained 49,660 patients (M1⁄435,145; IR1⁄414,515); those undergoing IR were further classified (TE/ I1⁄410,994; AT1⁄43,521). Odds of readmission were higher for those undergoing IR (OR 1.29, 95%CI 1.14e1.47), with Medicaid (OR 1.63, 95%CI 1.38-1.94) or Medicare (OR 1.56, 95%CI 1.381.75), with 3+ comorbidities (OR 3.92, 95%CI 3.20-4.82), and undergoing inpatient procedures (OR 1.42, 95%CI 1.24-1.62). Rates of wound infection (M1⁄431%, TE/I1⁄428%, AT1⁄433%, p1⁄40.33) and seroma/hematoma (M1⁄415%, TE/I1⁄412%, AT1⁄415%, p1⁄40.36) were similar; however, patients undergoing M had the highest rates of medical complications (M1⁄433%, TE/ I1⁄410%, AT1⁄419%, p