儿童癌症幸存者具有多种慢性疾病的连续性和护理协调：儿童癌症幸存者研究的结果
Continuity and coordination of care for childhood cancer survivors with multiple chronic conditions: Results from the Childhood Cancer Survivor Study
影响因子:5.10000
分区:医学1区 Top / 肿瘤学2区
发表日期:2024 Dec 15
作者:
Claire Snyder, Katherine C Smith, Wendy M Leisenring, Kayla L Stratton, Cynthia M Boyd, Youngjee Choi, Lorraine T Dean, Melissa M Hudson, Eric J Chow, Kevin C Oeffinger, Elyse R Park, Aaron J McDonald, Gregory T Armstrong, Paul C Nathan
摘要
具有多种慢性病的儿童癌症幸存者的连续性和护理协调对适当的后续护理进行了研究。该调查询问了幸存者的主要（照顾大多数医疗保健）和协调（确保跟进）提供商，产生了三个照料协调摘要分数（主要提供者，跨多个提供者，患者提供者的合作伙伴关系），其中包括六个不连续指标（例如，必须组织自身护理）。不连续性（是/否）被定义为一个或多个不连续项的不良护理。卡方检验评估了不连续性和社会人口统计学之间的关联。修改后的泊松回归模型估计的患病率比率（PRS），用于与特殊和年数相关的不连续性风险，而在三种护理协调汇总措施上与更好的分数相关的年限以及与更好的分数相关的PR。针对调查的非参与调查调整的反可能性权重。总共377（47％）的幸存者反应（平均年龄48岁，女性68％，非西班牙裔白人，78％私人保险，74％≥CollegeGrade Grade，78％）； 147/373（39％）报告了不连续性。年轻的幸存者更有可能报告不连续性（卡方P = .02）。看到主要提供商≤3年与更普遍的不连续性有关（PR; 95％CI）（1.17; 1.02-1.34vs≥10年）。癌症专家的主要提供者与较少的不连续性有关（0.81; 0.66-0.99与初级保健）有关。在所有三个护理协调摘要措施上的得分更好与多个提供者（0.81; 0.78-0.83）的主要提供者（0.73; 0.64-0.83）相关的较少的分数与患者提供的伙伴关系（0.85; 0.80-0.89; 0.80-0.89）.care Pare care Child neversions and Childs cancer Cervors and Privinents and Privinentival and Priventions and Privention and Privistion and Privistion。
Abstract
Continuity and coordination-of-care for childhood cancer survivors with multiple chronic conditions are understudied but critical for appropriate follow-up care.From April through June 2022, 800 Childhood Cancer Survivor Study participants with two or more chronic conditions (one or more severe/life-threatening/disabling) were emailed the "Patient Perceived Continuity-of-Care from Multiple Clinicians" survey. The survey asked about survivors' main (takes care of most health care) and coordinating (ensures follow-up) provider, produced three care-coordination summary scores (main provider, across multiple providers, patient-provider partnership), and included six discontinuity indicators (e.g., having to organize own care). Discontinuity (yes/no) was defined as poor care on one or more discontinuity item. Chi-square tests assessed associations between discontinuity and sociodemographics. Modified Poisson regression models estimated prevalence ratios (PRs) for discontinuity risk associated with the specialty and number of years seeing the main and coordinating provider, and PRs associated with better scores on the three care-coordination summary measures. Inverse probability weights adjusted for survey non-participation.A total of 377 (47%) survivors responded (mean age 48 years, 68% female, 89% non-Hispanic White, 78% privately insured, 74% ≥college graduate); 147/373 (39%) reported discontinuity. Younger survivors were more likely to report discontinuity (chi-square p = .02). Seeing the main provider ≤3 years was associated with more prevalent discontinuity (PR; 95%CI) (1.17; 1.02-1.34 vs ≥ 10 years). Cancer specialist main providers were associated with less prevalent discontinuity (0.81; 0.66-0.99 vs. primary care). Better scores on all three care-coordination summary measures were associated with less prevalent discontinuity: main provider (0.73; 0.64-0.83), across multiple providers (0.81; 0.78-0.83), patient-provider partnership (0.85; 0.80-0.89).Care discontinuity among childhood cancer survivors is prevalent and requires intervention.