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Health Serv Res Manag Epidemiol. 2016 May 9;3:2333392816646670. doi: 10.1177/2333392816646670. eCollection 2016 Jan-Dec.

Emergency Presentation and Short-Term Survival Among Patients With Colorectal Cancer Enrolled in the Government Health Plan of Puerto Rico.

Author information

1
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA.
2
Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA.
3
Department of Gastrointestinal Oncology and Genetics, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA.
4
Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA.

Abstract

OBJECTIVE:

In this study, we examine factors associated with the use of the emergency room (ER) as an entry point into the health-care system to initiate a cancer diagnosis among Puerto Rico's Government Health Plan (GHP) patients and compare the 1-year survival of GHP patients that initiated cancer diagnosis in the emergency room (ER) presentation with those that initiated the diagnosis in a physician's office.

METHODS:

Data for patients with colorectal cancer (CRC) aged 50 to 64 years and diagnosed in 2012 were obtained from the Puerto Rico Central Cancer Registry and linked to the Puerto Rico Health Insurance Administration database (n = 190). Crude odds ratio, adjusted odds ratio, and their 95% confidence intervals were reported. We used the Kaplan-Meier method to generate survival curves. Multivariate Cox regression analysis was performed to evaluate the association between ER presentation and 1-year cause-specific survival.

RESULTS:

We found that 37.37% of the study population had an ER presentation. Male patients had a higher occurrence of having an ER presentation (66.20%), while 76.06% of the patients with an ER presentation were diagnosed in late stage. Emergency room presentation was a highly predictive factor for cancer mortality in the year following the diagnosis. These patients had between 3.99 to 4.24 times higher mortality risk than non-ER presentation patients (P < .05).

CONCLUSION:

Late presentation for CRC diagnosis through an ER visit is a significant concern that influences negatively on the patient's outcome. Efforts at increasing primary care visits and routine screening tests among GHP beneficiaries could improve survival.

KEYWORDS:

Puerto Rico; colorectal cancer; delayed diagnosis; delivery of health care; emergency room; managed care programs; primary care; survival analysis

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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