Association of Care Coordination and Discontinuity With Patterns of Care and Outcomes in Childhood Cancer Survivors With Multiple Chronic Conditions: A Report From the Childhood Cancer Survivor Study
Claire Snyder, Rebecca Eary, Wendy M. Leisenring, Kayla L. Stratton, Cynthia M. Boyd, Lorraine T. Dean, Melissa M. Hudson, Eric J. Chow, Kevin C. Oeffinger, Elyse R. Park, Maura M. Kepper, Sara Malone, I‐Chan Huang, Matthew J. Ehrhardt, Vikki Nolan, Gregory T. Armstrong, Paul C. Nathan, Youngjee ChoiABSTRACT
Introduction
Given the substantial chronic condition burden among adult survivors of childhood cancer, we explored associations between care coordination and discontinuity with patterns of care and health status.
Methods
Data from Childhood Cancer Survivor Study (CCSS) participants with multiple chronic conditions who completed the validated CC‐MC measure of care coordination and discontinuity in 2022 were linked with data from 2019 to 2021 on emergency department [ED] visits, hospitalizations, risk‐based survivorship care advice, recommended screenings, and health status (SF‐36, Brief Symptom Inventory [BSI‐18]). Independent variables included three CC‐MC coordination summary scores: main provider (knowing the patient and coordinating their care), multiple provider (coordinating care within and across clinics), patient‐provider partnership (explaining things, considering patient goals); and discontinuity (dichotomous). Adjusted generalized linear models estimated prevalence ratios (PR), rate ratios (RR), and beta coefficients.
Results
Participants ( n = 365) were mean age 48.2 years, 68.5% female, 90.1% non‐Hispanic White. Better main provider (RR = 0.87; 95% CI: 0.77–0.99) and multiple provider (RR = 0.85; 95% CI: 0.80–0.90) scores were associated with less ED use; better multiple provider scores with fewer hospitalizations (RR = 0.88; 95% CI: 0.81–0.96); and better patient‐provider partnership scores with receiving risk‐based survivorship care advice (PR = 1.04; 95% CI: 1.01–1.08). We found no consistent associations between CC‐MC scores and recommended screening, though screening rates were generally high. All three CC‐MC summary scores were associated with fewer BSI global severity score elevations (PR range: 0.62–0.84). Discontinuity was associated with more hospitalizations (RR = 1.61; 95% CI: 1.03–2.51) and BSI global severity score elevations (PR = 4.20; 95% CI: 1.74–10.16).
Conclusion
Promoting care coordination across multiple providers and improving continuity may improve care and outcomes in this vulnerable population.