Quality of Cancer Survivorship Care in the Military Health System (TRICARE)
Quality of Cancer Survivorship Care in the Military Health System (TRICARE)
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DOI：
10.1097/ppo.0b013e3182821930
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发表时间：
2013-01-01
期刊：
影响因子：
2.2
通讯作者：
Gross, Cary P.
中科院分区：
文献类型：
--
作者：
Fox, Justin P.;Jeffrey, Diana D.;Gross, Cary P.
目的：在治疗的急性期之后，国家指南建议癌症幸存者与医疗保健提供者进行常规接触，并接受基本的辅助检测，同时避免高成本成像（HCI）。我们进行了这项研究，以确定如何频繁的乳腺癌，前列腺癌和结直肠癌的幸存者在survivorship period.Methods：使用行政数据TRICARE受益人，我们确定了一个队列的患者谁是乳腺癌，前列腺癌，或结直肠癌治疗2005年10月至2007年3月。这些患者随后随访至2010年9月。在3年后的初步治疗，我们确定了如何频繁的幸存者接受所有最低限度的建议生存护理所定义的国家指南，并进行HCI测试，如果这些结果不同的地理region.Results：总体而言，3148例患者接受治疗乳腺癌（n = 1630），前列腺癌（n = 1173），或结直肠癌（n = 345）。65%的患者在3年内接受了所有最低推荐护理（乳腺= 74.1%，前列腺= 65.3%，结直肠= 25.5%）。在3年期间，74.1%的乳腺癌幸存者每年接受乳房X光检查，而69.1%的结直肠癌幸存者至少接受1次结肠镜检查。64%的患者在3年期间至少进行了1次HCI研究（正电子发射断层扫描= 10.9%，计算机断层扫描= 48.8%，磁共振成像= 36.6%），费用为350万美元。大量的国家级的变化，注意到这两个outcome.Discussion：一些癌症幸存者不接受建议的护理后，初步治疗，而经常进行HCI。现有的质量和成像利用的地理差异表明，改善癌症生存护理是可能的。
Purpose: Following the acute phase of treatment, national guidelines recommend cancer survivors have routine contact with health care providers and undergo basic ancillary testing while avoiding high-cost imaging (HCI). We conducted this study to determine how frequently breast, prostate, and colorectal cancer survivors received recommended follow-up care and HCI tests during the survivorship period.Methods: Using administrative data from TRICARE beneficiaries, we identified a cohort of patients who were treated for breast, prostate, or colorectal cancer between October 2005 and March 2007. These patients were then followed through September 2010. During the 3 years after initial treatment, we determined how frequently survivors received all minimum recommended survivorship care as defined by national guidelines and underwent HCI tests and if these outcomes varied by geographic region.Results: Overall, 3148 patients underwent treatment for breast (n = 1630), prostate (n = 1173), or colorectal (n = 345) cancer. Sixty-five percent received all minimum recommended care over 3 years (breast = 74.1%, prostate = 65.3%, colorectal = 25.5%). During the 3-year period, 74.1% of breast cancer survivors received a mammogram each year, whereas 69.1% of colorectal cancer survivors had at least 1 colonoscopy. Sixty-four percent had at least 1 HCI study during the 3-year period (positron emission tomography = 10.9%, computer tomography = 48.8%, magnetic resonance imaging = 36.6%) at a cost of $3.5 million. Substantial state-level variation was noted for both outcomes.Discussion: Some cancer survivors do not receive recommended care following initial treatment while frequently undergoing HCI. The existing geographic variation in quality and imaging utilization suggests that improvements to cancer survivorship care are possible.