Measuring colorectal cancer care quality for the publicly insured in New York State.
Measuring colorectal cancer care quality for the publicly insured in New York State.
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DOI：
10.1002/cam4.30
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发表时间：
2012-12
期刊：
影响因子：
4
通讯作者：
Schrag, Deborah
中科院分区：
文献类型：
--
作者：
Sinclair, Amber H.;Schymura, Maria J.;Boscoe, Francis P.;Yung, Rachel L.;Chen, Kun;Roohan, Patrick;Tai, Eric;Schrag, Deborah
在公众投保者中，与结直肠癌治疗质量指标的一致性程度因患者特征的不同而不同，这一点尚不清楚。我们的目标是评估纽约州(NYS)公共保险居民的结直肠癌护理质量。纽约癌症登记数据与医疗补助和医疗保险索赔以及医院出院数据有关。我们确定了2004年至2006年确诊的结直肠癌病例，并评估了三种治疗质量指标：美国联合癌症委员会(AJCC)III期结肠癌确诊后4个月内辅助化疗，AJCC IIB期或III期直肠癌确诊后6个月内辅助放射治疗，AJCC II-III期直肠癌确诊后9个月内辅助化疗。对65岁以下的联邦医疗补助参与者和65-79岁的联邦医疗保险参与者分别评估了与指南的一致性。对于结肠癌的辅助化疗，79.4%(274/345)的Medicaid队列和71.8%(585/815)的Medicare队列的指南符合。对于直肠癌的辅助放射治疗，72.3%(125/173)的Medicaid队列和66.9%(206/308)的Medicare队列符合。对于直肠癌的辅助化疗，89.5%(238/266)的Medicaid队列和76.0%(392/516)的Medicare队列符合。在医疗保险队列中，年龄越小，调整后的所有三项指标的一致性几率越高。在两个队列中，种族差异都不明显。在与公认的癌症护理质量指标的一致性方面有改进的空间。有关绩效的反馈可能有助于针对改善护理的努力。
The extent to which concordance with colorectal cancer treatment quality metrics varies by patient characteristics in the publicly insured is not well understood. Our objective was to evaluate the quality of colorectal cancer care for publicly insured residents of New York State (NYS). NYS cancer registry data were linked to Medicaid and Medicare claims and hospital discharge data. We identified colorectal cancer cases diagnosed from 2004 through 2006 and evaluated three treatment quality measures: adjuvant chemotherapy within 4 months of diagnosis for American Joint Cancer Committee (AJCC) stage III colon cancer, adjuvant radiation within 6 months of diagnosis for AJCC stage IIB or III rectal cancer, and adjuvant chemotherapy within 9 months of diagnosis for AJCC stage II–III rectal cancer. Concordance with guidelines was evaluated separately for Medicaid-enrollees under age 65 years and Medicare-enrollees aged 65–79 years. For adjuvant chemotherapy for colon cancer, 79.4% (274/345) of the Medicaid cohort and 71.8% (585/815) of the Medicare cohort were guideline concordant. For adjuvant radiation for rectal cancer, 72.3% (125/173) of the Medicaid cohort and 66.9% (206/308) of the Medicare cohort were concordant. For adjuvant chemotherapy for rectal cancer, 89.5% (238/266) of the Medicaid cohort and 76.0% (392/516) of the Medicare cohort were concordant. Younger age was associated with higher adjusted odds of concordance for all three measures in the Medicare cohort. Racial differences were not evident in either cohort. There is room for improvement in concordance with accepted metrics of cancer care quality. Feedback about performance may assist in targeting efforts to improve care.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
45.3
作者：
Ayanian, JZ;Zaslavsky, AM;Wright, WE
通讯作者：
Wright, WE
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
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作者：
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通讯作者：
Fitzgerald, Timothy L.
影响因子：
6.2
作者：
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通讯作者：
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