Kim Rhoads, MD, MS, MPH

2005-2006

California Endowment Scholar in Health Policy (2005-2006)

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 a board certified general surgeon who most recently completed subspecialty training at the University of California, San Francisco's Mt. Zion Cancer Center in colorectal surgery. She also held a position as a postdoctoral research fellow at the UCSF Institute for Health Policy Studies. She has an extensive research background with experience in translational basic science research, qualitative methods and secondary data analysis. In addition to publishing many peer-reviewed journal articles and case reports, she has authored multiple book chapters, in both general and colorectal surgery texts. Her current research focuses on the impact of statewide quality improvement efforts and public reporting on postoperative cancer survival in California. Dr. Rhoads’ volunteer activities include work on behalf of Operation Access, a service and outreach non-profit organization providing ambulatory surgery to uninsured patients, and recruiting underserved high school and college students into careers in the health care field. She spent three years as board secretary for the Bay Area Black Women's Health Project where she spearheaded the organization's first health policy roundtable and lobby day training for Bay Area African American women. As a Legislative Intern at the American Medical Women’s Association in Washington, DC, she drafted AMWA's national position paper on the Health Status of Minority Women; and as an intern in the Office of then state Assemblywoman Barbara Lee, she organized and hosted a multidisciplinary effort to educate elderly African American women about breast cancer. She is a member of the Alpha Omega Alpha honor society at the University of California, San Francisco and was honored during her surgical training for excellence in research and compassion. She has most recently been selected to receive the Robert Wood Johnson Harold Amos Career Development Award for 2009-2013.

Dr. Rhoads holds a Master of Science degree in Health and Medical Science from the University of California, Berkeley School of Public Health, and she received her medical degree in 1998 from the University of California, San Francisco, School of Medicine. Dr. Rhoads completed her surgical residency at University of California, San Francisco, CA in June 2005. She received her Master of Public Health at Harvard School of Public Health as a California Endowment Scholar in 2005. During her time as a Scholar, Dr. Rhoads produced a documentary video outlining the history of the development of the Commonwealth Fund/Harvard University Fellowship/California Endowment Scholarship and JLH programs. She currently serves as Treasurer of the programs’ Alumni organization.


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