New York State (NYS) passed the Breast Cancer Provider Discussion Law in 2010 mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstructive rates. This study examines the impact of this law.
A retrospective cohort study of the NYS Planning and Research Cooperative System (SPARCS) database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by socio-demographic factors and provider types.
The study included 32,452 patients. Volume of mastectomies decreased from 5577 in 2008 to 4566 in 2013; the rate of reconstruction increased from 56% in 2008 to 61% in 2013. This rise was seen across all median income brackets (MIB), races, and age groups. When comparing pre- and post-law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans (AA) and elderly patients but the disparity in reconstruction rates did not change for other races, different income levels or insurance types. Reconstructive rates were also not significantly different between those treated at various hospital settings.
The aim of the Breast Cancer Provider Discussion Law is to improve reconstructive rates through provider-driven patient education. Our data shows significant change following law passage in AA and elderly populations, suggesting effectiveness of the law. The NYS Provider Discussion Law may provide a template for other states to model legislation geared towards patient-centered improvement of health outcomes.
1NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
2StatinMed Research, Plano, TX
Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript
FINANCIAL DISCLOSURES AND PRODUCTS: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript
Corresponding Author: Christine Hsu Rohde, MD, MPH, FACS, Division of Plastic Surgery, Suite 511, 161 Fort Washington Ave., New York, NY 10032, Tel: 1-212-342-3707 Fax: 1-212-305-9626, Email: Chr2111@cumc.columbia.edu