Inadequate access to surgeons: reason for disparate cancer care?
Inadequate access to surgeons: reason for disparate cancer care?
复制标题
无法充分接触外科医生：癌症护理不同的原因？
DOI：
10.1097/mlr.0b013e31819e1f17
复制
发表时间：
2009
期刊：
影响因子：
3
通讯作者：
Given,CharlesW
中科院分区：
文献类型：
--
作者：
Bradley,CathyJ;Dahman,Bassam;Given,CharlesW
目的：比较具有双重资格的老年非小细胞肺癌 (NSCLC) 和结肠癌患者与医疗保险患者去看外科医生的可能性。还评估了由外科医生评估的双重资格患者和医疗保险患者之间的手术率。方法：我们使用全州医疗补助和医疗保险数据与密歇根肿瘤登记处合并，提取首例原发性非小细胞肺癌（n = 1100）或结肠癌（n = 2086）患者的样本。研究期间为1997年1月1日至2000年12月31日。我们使用逻辑模型评估了手术评估的可能性，其中包括患者特征、肿瘤分期和人口普查区。在由外科医生评估的患者中，我们使用逻辑回归来预测是否进行切除。结果：双重合格的患者接受外科医生评估的可能性几乎是 Medicare 患者的一半（优势比 [OR]= 0.49；95% 置信区间= 0.32、0.77，优势比= 0.59；非小细胞肺癌和结肠癌患者的 95% 置信区间分别为 0.41、0.86）。在接受外科医生评估的患者中，双重资格患者和医疗保险患者之间的切除可能性没有统计学上的显着差异。结论：这项研究表明，尽管拥有医疗补助保险，双重资格患者相对于医疗保险患者而言接受外科医生评估的可能性较小。需要旨在增加接触专家和完成诊断检查（例如结肠镜检查、支气管镜检查）的政策和干预措施。
Objective:To compare the likelihood of seeing a surgeon between elderly dually eligible non–small-cell lung cancer (NSCLC) and colon cancer patients and their Medicare counterparts. Surgery rates between dually eligible and Medicare patients who were evaluated by a surgeon were also assessed.Methods:We used statewide Medicaid and Medicare data merged with the Michigan Tumor Registry to extract a sample of patients with a first primary NSCLC (n= 1100) or colon cancer (n= 2086). The study period was from January 1, 1997 to December 31, 2000. We assessed the likelihood of a surgical evaluation using logistic models that included patient characteristics, tumor stage, and census tracts. Among patients evaluated by a surgeon, we used logistic regression to predict if a resection was performed.Results:Dually eligible patients were nearly half as likely to be evaluated by a surgeon as Medicare patients (odds ratio [OR]= 0.49; 95% confidence interval= 0.32, 0.77 and odds ratio= 0.59; 95% confidence interval= 0.41, 0.86 for NSCLC and colon cancer patients, respectively). Among patients who were evaluated by a surgeon, the likelihood of resection was not statistically significantly different between dually eligible and Medicare patients.Conclusions:This study suggests that dually eligible patients, in spite of having Medicaid insurance, are less likely to be evaluated by a surgeon relative to their Medicare counterparts. Policies and interventions aimed toward increasing access to specialists and complete diagnostic work-ups (eg, colonoscopy, bronchoscopy) are needed.