Health Service Use in the Elderly with Cancer

描述(申请人提供)：乳腺癌、结直肠癌和前列腺癌等常见癌症的5年相对存活率很高，这意味着患有这些癌症的人应该接受推荐的预防服务，以及对其他共存的慢性病提供高质量的护理。该项目将测试建议的临床预防服务和护理质量指南在患癌症的老年美国人中是否与非癌症老年人一样频繁地得到满足。我们会研究的服务包括：(A)流感疫苗注射；(B)糖尿病的护理质素措施：每年测定血清血红蛋白Alc、血清低密度脂蛋白、眼科检查和肾病监测；以及(C)乳癌、结直肠癌和前列腺癌的筛查。我们将研究监测、流行病学和最终结果(SEER)中确定的老年联邦医疗保险服务费受益人-联邦医疗保险与1999年发生的乳腺癌、结直肠癌或前列腺癌，或1996年或1997年发生的乳腺癌或前列腺癌相关的数据库。具体地说，我们将：1.比较新诊断的癌症患者在完成初步治疗后一段时间内推荐护理的利用率与居住在SEER地区的5%没有患癌症的老年美国人的利用率；2.在有足够的统计力量的情况下，我们将比较多数人口(非西班牙裔白人)与少数群体：非西班牙裔黑人、西班牙裔和亚洲人对服务的使用情况。此外，我们将对被诊断为原位癌或局部癌症的患者与患有局部或远处疾病的患者进行分层子集分析，比较这些措施的使用情况。作为这项研究的结果，提供者将知道是否需要更多地强调向所有患有这些类型癌症的人或向人口中的某些亚群提供这些服务。

DESCRIPTION (provided by applicant): High 5-year relative survival rates for common cancers types such as breast, colorectal and prostate, mean that persons with these cancers should receive recommended preventive services, as well a high quality care for other co-existing chronic diseases. This project will test if recommended clinical preventive services and quality of care guidelines are met as frequently among elderly Americans who develop cancer as among elderly persons without cancer. The services we will study are (a) influenza immunization; (b) the diabetes quality of care measures: annual determination of serum hemoglobin Alc, serum low-density lipids, eye examination, and monitoring for nephropathy; and (c) screening for breast, colorectal and prostate cancer. We will study elderly Medicare fee-for-service beneficiaries identified in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database with incident breast, colorectal or prostate cancer in 1999, or incident breast or prostate cancer in 1996 or 1997. Specifically, we will: 1. Compare the rates of utilization of the recommended care in the newly diagnosed cancer patients in the period after the completion of initial treatment to the rates in a 5% sample of elderly Americans living in SEER areas who do not have cancer; 2. where sufficient statistical power exists, we will compare the use of services in the majority population (non-Hispanic whites) with the minority population groups: non-Hispanic blacks, Hispanics and Asians. In addition, we will do a stratified sub-set analysis of use of these measures among persons who are diagnosed with carcinoma in situ or localized cancer compared with those with regional or distant disease. As a result of this study, providers will know if an increased emphasis needs to be placed on providing these services to all persons with these types of cancer or to certain sub-groups of the population.