OBJECTIVES: Despite the rapid proliferation of robot-assisted radical prostatectomy (RARP), little attention has been paid to patient utilisation of this newest surgical innovation and barriers that may result in disparities in access to RARP.
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The goal of this study is to identify demographic and economic factors that decrease the likelihood of patients with prostate cancer (PC) receiving RARP.
DESIGN, SETTING AND PARTICIPANTS: A retrospective, pooled, cross-sectional study was conducted using 2009-2011 California State Inpatient Data and American Hospital Association data. Patients who were diagnosed with PC and underwent radical prostatectomy (RP) from 225 hospitals in California were identified, using ICD-9-CM diagnosis and procedure codes.
PRIMARY OUTCOME MEASURES: Patients' likelihood of receiving RARP was associated with patient and hospital characteristics using the two models: (1) between-hospital and (2) within-hospital models. Multivariate binomial logistic regression was used for both models. The first model predicted patient access to RARP-performing hospitals versus non-RARP-performing hospitals, after adjusting for patient and hospital-level covariates (between-hospital variation). The second model examined the likelihood of patients receiving RARP within RARP-performing hospitals (within-hospital variation).
RESULTS: Among 20,411 patients who received RP, 13,750 (67.4%) received RARP, while 6661 (32.6%) received non-RARP. This study found significant differences in access to RARP-performing hospitals when race/ethnicity, income and insurance status were compared, after controlling for selected confounding factors (all p< 0.001). For example, Hispanic, Medicare and Medicaid patients were more likely to be treated at non-RARP-performing hospitals versus RARP-performing hospitals. Within RARP-performing hospitals, Medicaid patients had 58% lower odds of receiving RARP versus non-RARP (adjusted OR 0.42, p< 0.001). However, there were no significant differences by race/ethnicity or income within RARP-performing hospitals.
CONCLUSIONS: Significant differences exist by race/ethnicity and payer status in accessing RARP-performing hospitals. Furthermore, payer status continues to be an important predictor of receiving RARP within RARP-performing hospitals.
Kim J, ElRayes W, Wilson F, Su D, Oleynikov D, Morien M, Chen LW. Are you the author?
Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA; Department of Health Promotion, Social and Behavioral Health, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA; Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Reference: BMJ Open. 2015 May 3;5(4):e007409.