Date of Award

6-1-2012

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Jerry Cromwell

Second Advisor

Christopher S. Lathan

Third Advisor

Patricia Reid Ponte

Abstract

Purpose - The EGFR assay is a molecular diagnostic test which identifies a targetable mutation in lung tumors. Guidelines call for EGFR testing for non-small cell lung cancer patients to direct first line treatment. We explored institutional and regional factors predicting the likelihood acute care hospitals ordered the assay. Methods: This was a retrospective study which analyzed US acute care hospitals (n=4780). We linked proprietary industry data for orders of the EGFR assay to public datasets that provided hospital and regional characteristics. We conducted logistic regression to identify significant characteristics that predict likelihood a hospital ordered the assay. Results - Of acute care hospitals in the US, 12% (n=592) ordered the EGFR assay. In 49 counties with an NCI designated cancer center (NCI CC), 19% of hospitals ordered the assay. Significant institutional predictors of ordering the assay included: Participation in an NCI clinical research cooperative group (odds ratio [OR], 1.91, 95% CI 1.55 to 2.35), inpatient chemotherapy (OR, 1.32; 95% CI, 1.00 to 1.74), Cardio Thoracic Surgery (OR, 1.70; 95% CI, 1.37 to 2.11), and affiliation with academic medical center (OR, 1.40; 95% CI, 1.14 to 1.72). Significant regional predictors included: metropolitan county (OR, 1.70; 95% CI, 1.24 to 2.32), education above the mean (OR, 1.45; 95% CI, 1.10 to 1.91). Negative predictors were distance from an NCI CC (OR, .996, 95% CI, .995 to .998), a 34% decrease in likelihood for every 100 miles further from an NCI CC, and characterization as a critical access hospital (OR, .02, 95% CI, .00 to .09).

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