Abstract A130: Provider patient-sharing networks reduce colorectal cancer time-to-treatment: What is their relationship to survival?
Authors: Schiaffino Melody K , Nalawade Vinit , Shakya Holly , Murphy James D 
Published: September 2020

Abstract
Timely coordination of appropriate care is the current obsession of medical centers intent on delivering the greatest value to consumers of health services. Addressing the delivery of right care at the right time in the right place has been driving an over haul of the U.S. health care delivery system since the 2010 signing of the Patient Protection and Affordable Healthcare Act. The focus has been primarily on offering massive incentives for linking the fragmented segments of primary, secondary, and tertiary care across the gaping silos that have become our new norm. Much of this work lies at the feed of provider-provider incentives, effort, and communication. The purpose of the present study was to assess the role of provider to provider patient referral relationships. We want to determine whether these interpersonal interactions, that imply increased interaction, shared information exchange, and knowledge and expertise, also result in better outcomes for the patients that are in them. We used data from the 2004-2011 SEER-Medicare data set with permission, additional measures were gleaned with permission from the CMS Medicare PUF and the American Hospital Association Annual Database (2014). We had a final sample for analysis of N=27689. We calculated patient-sharing as the number of patients seen by the same diagnosing and treating provider within in the last 3 years. Most shared 1 patient, or were part of the reference group as not sharing. We also developed a measure of care-coordination to assess the effect of the diagnosing and treating provider being co-located on mortality. Kaplan Meier and cumulative incidence functions were calculated as well as Fine-Grey competing risk analysis of mortality from [not cancer] to ensure we accounted for variability. All analyses were conducted on SAS 9,4 (Cary, N.C.). We found providers that had moderate patient-sharing (2-6 patients) or strong (more than 6 shared patients) had HR under 1.00, compared to providers with only 1 referral from diagnosing to treating provider or no patient-sharing. Only when comparing no patient-sharing against moderate patient-sharing was a statistically significant hazard of death observed in the moderate group between the diagnosing and treating providers (HR 1.08, 95CI 1.02-1.14). We also found significant HR of 1.14 (p=.0010) that for risk of death compared to White patients. This exploratory look at SEER-Medicare data is a valuable foray into assessing the potential of massive administrative data to address the growing population of the U.S that is aging and in need of appropriate support to ensure optimal treatment and survival outcomes.
Citation Format: Melody K Schiaffino, Vinit Nalawade, Holly Shakya, James D Murphy. Provider patient-sharing networks reduce colorectal cancer time-to-treatment: What is their relationship to survival? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A130.