ASPO Abstracts
Healthcare utilization patterns among safety-net patients with cancer and multimorbidities
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: To examine how cancer diagnoses influence healthcare utilization for patients with multiple chronic
conditions receiving care in a county safety-net health system.
Methods: We conducted a mixed-methods study examining healthcare utilization of patients served by Parkland
Health and Hospital System in Dallas County, TX. We used electronic health record data to randomly select 631
cases defined as patients diagnosed with Stage I-III breast or colorectal cancer during 2010 to 2016 AND at least
one other chronic condition. Controls, comprised of a random sample of patients with at least two chronic
conditions and no history of cancer, were matched to cases on gender and comorbidity risk profile (i.e. Charlson
score). Multi-level regression models compared healthcare utilization patterns of cases and controls. Semi-
structured interviews (n=20 patients) assessed experiences with healthcare processes and referrals between
primary care and specialty care. Transcripts were thematically analyzed in an iterative deductive and inductive
coding scheme to identify anticipated and emergent findings.
Results: After adjusting for comorbidity risk profile scores, cases had significantly lower number of encounters with
the health system compared to controls (N=46,960 vs. 146,229). Both quantitative and qualitative findings
indicated that cases were more likely to visit oncology and less likely to visit primary care (IRR=0.18; 95% CI:
0.16, 0.20) and the emergency department (IRR=0.15; 95% CI: 0.13, 0.18) compared to controls. Cancer patients
were more likely to complete an appointment (AOR=4.83; 95% CI: 4.32, 5.39) compared to controls. Interviewed
cases indicated a pattern of not seeking primary care appointments for various reasons, including not
understanding the purpose of primary care visits as they received urgent services in oncology for chronic
conditions.
Conclusions: Health systems need to find innovative, effective solutions to increase primary care utilization among
cancer patients with chronic care conditions. Oncology is not the ideal location for these services, as it is an
inefficient use of resources. Further, care quality measures for chronic conditions may be inadequately addressed,
ultimately impacting the long-term survival of cancer patients.
Keywords: healthcare utilization, complex cancer patients, cancer disparities