Kim Rhoads, MD, MS, MPH

2005-2006

California Endowment Scholar in Health Policy

Associate Professor of Epidemiology & Biostatistics, University of California San Francisco; Director, Office of Community Engagement and Associate Director for Community Outreach and Engagement, UCSF Helen Diller Family Comprehensive Cancer Center; San Francisco, CA

Dr. Rhoads is an associate Professor of Epidemiology and Biostatistics and the Director of the Office of Community Engagement for the UCSF Helen Diller Family Comprehensive Cancer Center (HDFCCC).  Rhoads has formal training and board certification in general and colon and rectal surgery and founded the pelvic floor clinic at Stanford, developing a regional reputation for pelvic floor reconstruction and management of functional disorders.  Dr. Rhoads conducts health services research highlighting the relationship between the delivery of evidence-based cancer care and survival disparities for racial/ethnic minorities in California.  Her groundbreaking work has demonstrated the link between cancer care equity and the closure of racial/ethnic survival gaps in a variety of malignancies. 

Rhoads’ longstanding commitment to community engagement as a path to eliminating disparities led to her current role as the Director of the Office of Community Engagement for the UCSF HDFCCC. In this role, she provides leadership for institutional investigators in their engagement with communities to enhance both research and practice intended to reduce the burden of cancer, address inequities in care and reduce disparities in survival.  Dr. Rhoads is also the founding Director of Umoja Health, a community coalition born in 2020 to rapidly mobilize to address the COVID-19 disparities facing communities of color.  Its focus has been on building community coalitions with the capacity to address the underlying causes of health inequities by dismantling systemic racism and reimagining healthcare delivery. Under Dr. Rhoads’s leadership, Umoja Health has grown to engage with more than 105 community-based partners and has reached more than 18,000 individuals with public health education, health screenings, and vaccinations, while also cultivating a diverse community workforce.  The effort centers community engagement, community data ownership, and efforts to transform institutions so that action is valued over talk, and impact is valued over impact factors. for COVID-19 education, testing resources, and vaccinations.

Dr. Rhoads earned her MD from the UCSF School of Medicine, a Master’s degree in Health and Medical Sciences from UC Berkeley, a Master’s degree in Public Health, Health Management and Policy, from the Harvard School of Public Health where she served as a California Endowment Scholar in minority health policy and was the inaugural Philip R. Lee Fellow in Health Policy at UCSF. Prior to her current Directorship at UCSF, Rhoads founded and led the Community Outreach and Engagement program at the Stanford Cancer Institute.

Learn more about the California Endowment Scholars in Health Policy at Harvard University.

 

October 16, 2021 | HSPH Magazine
Showing Up for the Underserved

The Impact of Hospital Type on Colorectal Cancer Outcomes in California

Background:

The American Cancer Society estimates that 14,000 cases of colorectal cancer will be diagnosed in Californians in 2004. Of those cases, more than one third will die of the disease. Although incidence and mortality rates have been declining in all populations over the last two decades, disparities in survival still persist for patients of color. Explanations for these differences in the literature site lack of insurance, patient comorbid states and differential treatment—sometimes mediated by low socioeconomic status (SES)—all contribute to poor outcomes. In the current study, we set out to determine whether or not these outcomes are mediated by hospital type, since many of these factors are proxy indicators for safety net hospital use.

Specific Aims:

The aim of this study is to determine whether or not hospital type impacts colorectal cancer outcomes in California. The hypothesis is that hospitals serving high numbers of Medicaid recipients would have worse outcomes than those serving fewer Medicaid patients. Secondarily, we hypothesized that neither academic affiliation, nor surgical volume would impact these outcomes.

Methods:

The California Office of Statewide Health Planning and Development, (OSHPD) collects patient discharge data for all inpatient admissions in the state. The California Cancer Registry is the largest and most complete cancer database in the world. Using linked administrative databases from these two agencies, we used ICD9 codes to identify all patients who had a primary diagnosis of colorectal cancer and primary procedure coding for receipt of surgical treatment for the disease. We defined high Medicaid hospitals (HMH) as those serving greater than 30% Medicaid patients. Non-high Medicaid hospitals were those serving fewer than thirty percent. Using SAS 9v1, we performed secondary data analysis on the following outcomes: post-surgical complications, inpatient, 30-day and 1-year mortality. Our primary multivariate model included age, gender, race, insurance status, co-morbidities and stage at diagnosis. Secondary models adjusted for academic affiliation and surgical volume.

Results:

Hospitals in California during 1998-99 performed 18,000 operations for colorectal cancer. Only 8% of those cases were performed in high Medicaid hospitals (p<.0001). High Medicaid hospitals served more patients of color, who were under- and uninsured. Patients using high Medicaid hospitals had higher rates of diabetes and hypertension, but lower rates of coronary artery disease and morbid obesity. These patients were less likely to present with early stage tumors. There were no differences in rates of chronic lung or kidney disease. In the univariate analysis, there were significantly higher rates of medical complications. Multivariate analysis revealed no differences in medical complications, but a slightly lower incidence of surgical complications by hospital type. High Medicaid hospitals had higher rates of inpatient mortality, 30-day mortality and 1-year mortality. The effects of hospital type were not attenuated by adjustment for academic affiliation, but the effect on 30-day mortality was neutralized by adjustment for surgical volume.

Conclusions:

High Medicaid hospitals serve the most vulnerable patients in California. Our study shows, however, that colorectal cancer care delivered in these hospitals does not compare favorably to care in hospitals delivered outside the safety net. It is not clear from our results if this is truly an issue related to funding, however, this question should be addressed in future studies. At the state level, however, it would be feasible to begin efforts in the public reporting arena and develop colorectal cancer centers of excellence. At the institutional level, our data suggest the need for assessing the role of colorectal fellowship trained surgeons at all safety net hospitals.

Preceptors:

Ashish Jha, MD
David Carlisle, MD, PhD