Association of Healthcare Fragmentation and the Survival of Patients With Colorectal Cancer in Colombia

The objective of this study was to identify the association between healthcare fragmentation and survival for patients with colorectal cancer in Colombia. A retrospective cohort study was performed using administrative databases, with an electronic algorithm to identify patients with colorectal cancer based on codes. The patients were enrolled between January 1, 2013, and December 31, 2016. The exposure variable was fragmentation, which was measured based on the number of different healthcare institutions that treated a patient during the first year after diagnosis. Matching was performed using propensity scores to control for confounding, and the hazard ratio for exposure to higher fragmentation was calculated for the matched sample. A total of 5036 patients with colorectal cancer were identified, 2525 (49.88%) of whom were women. The mean number of network healthcare institutions for the total sample was 5.71 (SD 1.98). The patients in the quartile with higher fragmentation had the highest mortality rate, 35.67 (95% CI 33.63-38.06) per 100 patients. The comparison of higher and lower quartiles of fragmentation resulted in an incidence rate ratio of 1.23 (95% CI 1.04-1.45; P = .02). Of the 5036 patients, 422 (8.38%) were classified as the exposed cohort (higher fragmentation). The total matched sample consisted of 844 subjects, and an HR of 1.26 (95%CI; 1.05-1.51) was estimated. Exposure to more highly fragmented healthcare networks decreases overall 4-year survival for patients with colorectal cancer in Colombia. •Healthcare fragmentation is a complex phenomenon in which patients experience a loss of continuity of care. Healthcare fragmentation is associated with poorer clinical and economic outcomes. Healthcare fragmentation mainly affects diseases that require multidisciplinary care such as cancer. Health systems in Latin America are vulnerable to providing fragmented healthcare.•This article defines a measure of healthcare fragmentation based on the number of healthcare institutions and describes regional differences in healthcare fragmentation and its association with colorectal cancer patient survival in a low- and middle-income country, using a national cohort from databases’ administrative data.•This article shows that fragmented healthcare is associated with lower survival in patients with cancer and that health systems must provide multidisciplinary teams that provide continuous and high-quality care to patients with cancer.