Combined changing patterns of hospital utilization for head and neck cancer care: implications for future care.

Importance: The care of patients with head and neck cancer is labor and cost intensive. Although several studies have focused on clinical outcomes with regionalization of care of such patients, it remains uncertain if and where such concentrations of care are occurring. A better understanding of how care is distributed will improve our understanding of the financial and educational impact of compacting treatment of these patients.

Objective: To determine if regionalization of head and neck cancer care has occurred over the past decade with respect to hospital size and teaching hospital status.

Design And Setting: Secondary analysis of national health care database.

Participants: All inpatient admissions with a primary head and neck cancer diagnosis contained within the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.

Main Outcomes And Measures: The percentage distributions of head and neck cancer cases with respect to hospital teaching status, hospital bed size, and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted to determine year-to-year changes in proportion of head neck cancer admissions, controlling for geographic region, hospital bed size, and expected source of payment.

Results: The estimated inpatient hospital head and neck cancer stays in the United States in 2000, 2005, and 2010 (with standard error of the national estimate) were 28,862 (2067), 33,517 (3080), and 37,354 (4194), respectively. The percentage of admissions to teaching hospitals increased from 61.7% to 64.2% and 79.8%, respectively. Similarly, the percentage (with standard error) of cases in large-bed-size hospitals increased from 69.2% (2.8%) to 71.4% (3.8%) and 73.3% (4.8%), respectively. The primary expected payer distribution did not change significantly over the study (Medicare, 39.6% [1.4%]; Medicaid, 17.4% [2.2%]; private insurance, 33.3% [2.4%]; and other, 9.7% [1.5%] in 2010). The adjusted odds ratio for head neck cancer case being admitted to a teaching institution for 2010 vs 2000 was 2.5 (95% CI, 1.6-3.7).

Conclusions And Relevance: Head and neck oncologic care is increasingly being regionalized to teaching hospitals and academic centers. Such regionalization also has important implications for future education of residents and measures of achieved competency.