Do the Characteristics of the Site of Care Influence Outcomes? Associations between Community Practice-Level Characteristics and Real-World Overall Survival Among Patients with Multiple Myeloma
Wang X1, Kaur M1, Altomare I1, Zhao Y1, Kelsh M2, Carrigan G2, Kim C2, Humblet O1
1Flatiron Health, Inc., New York, NY, USA, 2Amgen Inc., Thousand Oaks, CA, USA
OBJECTIVES: A common concern in using RWD is the heterogeneity of practices treating patients, and corresponding impact on patient outcomes. Here we describe the association of practice-level characteristics and real-world overall survival (rwOS) in multiple myeloma (MM) using nationwide community site data.
METHODS: This retrospective study used the US-based Flatiron Health electronic health record-derived de-identified database. We included patients diagnosed with MM between 1/1/2017-6/1/2022, with evidence of treatment at a community practice that was established prior to 2017. Descriptive statistics were summarized at the practice-level, including case-load (patient-physician ratio; numbers of visits, physicians, patients with cancer, and with MM), diversity (% Black patients, with Medicaid, low socioeconomic status, and rurality), location, and clinical factors (% received clinical study drugs, genetic testing, transplant and R-ISS workup). Mixed-effect Cox regression was performed to assess the association between practice-level characteristics and rwOS from first-line treatment, adjusting for patient-level demographic and clinical factors (conditional hazard ratio [cHR] and 95% confidence interval [CI]).
RESULTS: Among 4,552 patients with MM from 136 practices, wide distribution was observed for all 15 practice-level characteristics. Practices ranged from 1-163 physicians, 0-58% patients with Medicaid, 0-50% clinical study drug recipients, and 0-85% transplant recipients. No practice-level factors were associated with rwOS in univariate analyses, and 13 remained unassociated after adjustment. Lower hazard of death was seen among patients from practices with the highest quintile % transplant recipients compared to the lowest quintile (cHR=0.74; 95% CI: 0.55-1.00), and unexpectedly, among patients from practices with a higher % patients with Medicaid (cHR=0.76; 95% CI: 0.61-0.95).
CONCLUSIONS: In this hypothesis-generating study of patients with MM, we observed a wide variability in practice-level variables across community sites, yet rwOS was not strongly associated with most practice-level characteristics. Future studies in other care and oncological settings are needed, accounting for potential unmeasured confounding and interactions.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Real World Data & Information Systems
Distributed Data & Research Networks, Reproducibility & Replicability