Variation in quality of care among older men with localized prostate cancer.
Variation in quality of care among older men with localized prostate cancer.
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DOI：
10.1002/cncr.25812
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发表时间：
2011-06-01
期刊：
影响因子：
6.2
通讯作者：
Malkowicz, S. Bruce
中科院分区：
文献类型：
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作者：
Jayadevappa, Ravishankar;Chhatre, Sumedha;Johnson, Jerry C.;Malkowicz, S. Bruce
关键词：
评估结果的种族和民族差异及其与医疗保险老年局限性前列腺癌护理措施的相关性。我们使用了1995-2003年期间的SEER-Medicare数据库。确定了患有局限性前列腺癌的非裔美国人、非西班牙裔白色和西班牙裔男性，并获得了前列腺癌诊断前1年和诊断后8年的数据。短期结果为并发症、急诊就诊、再入院和死亡率。长期结果是前列腺癌特异性死亡率和全因死亡率。护理措施的过程是治疗和治疗时间。采用考克斯比例风险、逻辑回归和泊松回归研究结局的种族和民族差异及其与护理措施过程的相关性。与非西班牙裔白色患者相比，非洲裔美国患者（风险比[HR]，1.43; 95%置信区间[CE]，1.19-1.86）和西班牙裔患者（HR=1.39; 95% CI-1.03-1.84）的长期前列腺特异性死亡率风险更大。与白色患者相比，非裔美国人患者的ER访视几率（比值比=1.4，CI=1.2，1.7）和全因死亡率（HR=1.39，CI=1.3，1.5）更高。非裔美国人患者的治疗时间较长，表明全因长期死亡率的风险较高。与接受激素治疗的白色患者相比，接受手术或放疗的西班牙裔患者的长期前列腺特异性死亡率风险更高。结果的种族和民族差异与护理措施的过程（类型和治疗时间）相关。存在着通过处理护理措施过程来减少这些差异的机会。
To assess the racial and ethnic disparities in outcomes and their association with process of care measures for Medicare elderly with localized prostate cancer. We used SEER-Medicare databases for the period 1995–2003. African American, non-Hispanic white and Hispanic men with localized prostate cancer were identified and data was obtained for the one year period prior to the diagnosis of prostate cancer and up to eight years of post-diagnosis period. Short-term outcomes were complications, ER visits, readmissions and mortality. Long-term outcomes were prostate cancer-specific and all-cause mortality. Process of care measures were treatment and time to treatment. Cox proportional hazard, logistic and Poisson regressions were used to study the racial and ethnic disparities in outcomes and their association with process of care measures. Compared with non-Hispanic white patients, African-American patients (Hazard ration [HR], 1.43; 95% confidence interval [CE], 1.19-1.86) and Hispanic patients (HR=1.39; 95% CI-1.03-1.84) had greater hazard of long term prostate specific mortality. African American patients had higher odds of ER visits (Odds Ratio=1.4, CI=1.2, 1.7) and higher all-cause mortality (HR=1.39, CI=1.3, 1.5) compared to white patients. Time to treatment was longer for African American patients and was indicative of higher hazard of all-cause long-term mortality. Hispanic patients receiving surgery or radiation had higher hazard of long-term prostate-specific mortality compared to white patients receiving hormone therapy. Racial and ethnic disparity in outcome is associated with process of care measures (type and time to treatment). There exists opportunity to reduce these disparities by addressing the process of care measures.
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影响因子：
6.2
作者：
Jayadevappa, Ravishankar;Johnson, Jerry C.;Malkowicz, S. Bruce
通讯作者：
Malkowicz, S. Bruce
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
6.2
作者：
Miller, DC;Litwin, MS;Wei, JT
通讯作者：
Wei, JT
影响因子：
3
作者：
Miller, David C.;Spencer, Benjamin A.;Litwin, Mark S.
通讯作者：
Litwin, Mark S.
DOI：
10.2307/3348969
发表时间：
1966-01-01
期刊：
MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY
影响因子：
--
作者：
DONABEDIAN, A
通讯作者：
DONABEDIAN, A