Hispanic children diagnosed with brain tumors get
high-quality treatment at hospitals that
specialize in neurosurgery far less often than
other children with the same condition,
potentially compromising their immediate
prognosis and long-term survival, according to
research from Johns Hopkins published in OctoberÃâs Pediatrics.
More than a decade after the Institute of
MedicineÃâs landmark report Crossing the Quality
Chasm, the Johns Hopkins investigators say their
findings detect persistent gaps in access to
specialized care among certain patients, raising
questions about how far across the chasm we have actually come.
ÃâWhat was shocking to us was the finding that,
despite the push over the last decade to equalize
access to high-quality care, gaps are still
there, particularly among Hispanics, and, if
anything, they may be getting even worse,Ãâ said
lead investigator Raj Mukherjee, M.D., M.P.H., a
postdoctoral fellow in the Department of Neurosurgery at Johns Hopkins.
Research has shown that patients treated at
specialty hospitals that admit a high volume of
patients with similar conditions fare better in
the long and short term, investigators say. For
example, studies show that patients undergoing
brain surgeries in hospitals that perform the
fewest neurosurgeries have up to 16 times the
mortality rate of patients treated in hospitals performing the highest number.
ÃâGiven that brain tumors are the most common
solid tumors in children, lack of access to
specialized care simply means that thousands of
pediatric patients are getting less-than-optimal
treatment, putting them at risk for relapse and a
host of neurological complications,Ãâ says
pediatric neurosurgeon George Jallo, M.D.,
co-author of the study and director of
neurosurgery at the Johns Hopkins ChildrenÃâs Center.
The Johns Hopkins study, which looked at 4,421
children with brain tumors over the span of 18
years, found that access was worst among
Hispanics, as well as among those of lower
socio-economic status and those living in areas
with higher immigrant population and with few
neurosurgeons. Insurance did not play a role in
where a patient was treated, the researchers
found. The Johns Hopkins team linked two
databases -- one detailing hospital and patient
information and another one with demographic and
environmental information -- elucidating in a
novel way the impact of such factors as ethnicity
and proportion of foreign-born people in the county of residence.
Overall, only 37 percent of the patients in the
study who should have been treated at a
high-volume hospital had surgeries in such
institutions. Hispanics consistently fared worse
than the others: Even when adjusting for factors
that may affect access to care, such as
socioeconomic status and health insurance,
Hispanic children still got specialized care at
one-third the rate of other children, the Johns Hopkins team found.
ÃâIf youÃâre a Hispanic child diagnosed with a
brain tumor, youÃâre far less likely to get the
best possible treatment, and this is concerning
in and of itself, but thereÃâs another looming
threat emerging from our findings,Ãâ said senior
investigator Alfredo Quiñones-Hinojosa, M.D.,
associate professor of neurosurgery and oncology
at Johns Hopkins. ÃâHispanics will make up 25
percent of this countryÃâs population by the year
2050, so unless we do something about this, it
looks like in the next few decades, a quarter of
our population may end up getting substandard care.Ãâ
ÃâOur findings are yet another reminder that we
are at a unique crossroad in history as we try to
restructure our healthcare system, and we have
been given a chance to reduce, perhaps even
eliminate, these inequalities once and for all,Ãâ Quiñones adds.
Researchers say that pinpointing the exact
factors that determine who gets care and where
they get it requires carefully designed studies
that examine individual patient decision-making,
as well as systemic factors, such as insurance
and possible institutional bias in patient selection.
The research was funded in part by the Howard
Hughes Medical Institute, the ChildrenÃâs Cancer
Foundation and Johns Hopkins Center for Innovative Medicine.
Co-investigators in the study include Thomas
Kosztowski, B.S.; Hasan Zaidi, B.S.; Benjamin
Carson, M.D.; and David Chang, Ph.D., M.P.H., M.B.A.
Related on the Web:
Alfredo Quiñones-Hinojosa,
M.D.:
http://www.hopkinsmedicine.org/neurology_neurosurgery/experts/team_member_profile/36A35BDE9B71CB08318C8F419FD7ACB4/Alfredo_Quinones-Hinojosa
George Jallo:
http://www.hopkinschildrens.org/staffDetail.aspx?id=1502&terms=%40lastname_8+jallo
Raj Mukherjee:
http://commprojects.jhsph.edu/sommerscholars/scholar_detail.cfm?f=Debraj&l=Mukherjee
The Alfredo Story (Hopkins Medicine):
http://www.hopkinsmedicine.org/hmn/W07/feature1.cfm
The New York Times on Quinones:
http://www.nytimes.com/2008/05/13/science/13conv.html/?_r=2
See Dr. Jallo discussing a patient with a rare
tumor-Video
http://www.hopkinsmedicine.org/neurology_neurosurgery/video_gallery/jallo_spine_tumor_video.html
Dr. Quinones on neuroscience- Video
http://www.youtube.com/watch?v=Z9zYCZZMOnw
Johns Hopkins ChildrenÃâs Center: http://www.hopkinschildrens.org/
Pediatrics: http://www.pediatrics.org/
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Johns Hopkins Children's Center
Media contact: Ekaterina Pesheva
410-516-4996
epeshev1@jhmi.edu
October 8, 2009