Is medical home enrollment associated with receipt of guideline-concordant follow-up care among low-income breast cancer survivors?
Is medical home enrollment associated with receipt of guideline-concordant follow-up care among low-income breast cancer survivors?
复制标题
低收入乳腺癌幸存者中医疗之家的注册是否与接受符合指南的后续护理相关？
DOI：
10.1097/mlr.0b013e31828d4d0c
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发表时间：
2013
期刊：
影响因子：
3
通讯作者：
Domino,MarisaE
中科院分区：
文献类型：
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作者：
Wheeler,StephanieB;Kohler,RacquelE;Goyal,RaviK;Lich,KristenH;Lin,Ching-Ching;Moore,Alexis;Smith,TimothyW;Melvin,CathyL;Reeder-Hayes,Katherine;Domino,MarisaE
背景：北卡罗来纳州社区护理（CCNC）在20世纪90年代发起了一项创新的医疗之家计划，以改善医疗补助保险人群的初级保健。CCNC已成功改善哮喘、糖尿病和心血管结局，但尚未在癌症护理背景下进行评估。我们探讨了是否CCNC登记与指南一致的后续护理乳腺癌survivor.Methods：使用国家癌症登记记录相匹配的医疗补助要求，我们确定了妇女18至64岁的诊断为0期，I，II，或未分期乳腺癌，从2003年至2007年，并跟踪他们每月CCNC登记。使用已出版的美国临床肿瘤学会指南来定义我们的结果，我们采用多变量logistic回归来检查，作为一个功能的CCNC登记，接受乳房X线检查和至少2个物理检查/病史的观察窗口内访问与guidelines.Results一致：在840名妇女，大约一半的人在研究期间的一段时间内被纳入CCNC。40%至85%的女性根据指南接受了随访乳房X线检查，CCNC状态存在显著差异，95%的女性接受了至少2次体格检查/病史采集访视。在多变量模型中，增加月的CCNC登记显着正相关收到后续乳房X光检查，但不与体检/病史taking visits.Conclusions：结果表明，CCNC登记与医疗补助保险幸存者的指南一致的后续护理。鉴于癌症幸存者人口的不断增长和对初级保健医疗之家的日益重视，未来的研究应探讨哪些因素与医疗之家的参与有关，以及在长期随访中是否观察到类似的结果。
Background:Community Care of North Carolina (CCNC) initiated an innovative medical home program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes but has not been evaluated in the context of cancer care. We explored whether CCNC enrollment was associated with guideline-concordant follow-up care among breast cancer survivors.Methods:Using state cancer registry records matched to Medicaid claims, we identified women 18 to 64 years old who were diagnosed with stage 0, I, II, or unstaged breast cancer from 2003 to 2007 and tracked their monthly CCNC enrollment. Using published American Society for Clinical Oncology guidelines to define our outcomes, we employed multivariate logistic regressions to examine, as a function of CCNC enrollment, receipt of mammogram and at least 2 physical examinations/history-taking visits within observational windows consistent with the guidelines.Results:Of the 840 women, approximately half were enrolled into the CCNC for some time during the study period. Between 40% and 85% received follow-up mammogram in accordance with guidelines, with significant variation by CCNC status, and 95% of women received at least 2 physical examinations/history-taking visits. In multivariate models, increasing months of CCNC enrollment was significantly positively associated with receipt of follow-up mammogram but not with physical examinations/history-taking visits.Conclusions:Results suggest that CCNC enrollment is associated with guideline-concordant follow-up care for Medicaid-insured survivors. Given the growing population of cancer survivors and increased emphasis on primary care medical homes, future studies should explore what factors are associated with medical home participation and whether similar findings are observed with extended follow-up.