Health System Factors and Patient Outcomes in Breast Cancer

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DESCRIPTION (provided by applicant): Stakeholders from across the cancer community have stressed the need for research related to delivery system structure and processes to inform initiatives to improve the quality of care. Despite this growing demand for information, little rigorous research exists about how variations in practice characteristics and processes of cancer care delivery affect relevant patient outcomes. The specific aims of the proposed competing continuation study are: 1) To collect information on a population- based sample of 1800 female patients recently diagnosed with breast cancer derived from the Detroit SEER registry and their attending surgeons and oncologists via a self-administered mailed survey (or telephone survey option). Patient survey information will be augmented by sociodemographic and clinical data from the SEER registry; 2) To describe the variations reported by the clinicians in our sample in key delivery system process measures as well as in measures of physician and practice characteristics. The delivery system process measures assess availability of clinical information, provider team design, patient decision and care support, and practice management support. Physician characteristics include age, gender, race, number of years in practice, and volume of breast cancer-related practice. Practice characteristics include payer mix, university affiliation, teaching program status, practice size, cancer program status, and practice resources; 3) To examine the association of three patient outcomes with delivery system process measure scores. Patient outcomes include: 1) satisfaction with decision-making and evaluation of care processes; 2) the utilization of surgical and non-surgical treatments; and 3) health-related quality of life; and 4) To examine whether the association of patient outcomes with race or sociodemographic factors varies across delivery system process measure scores. The results from the proposed study will inform initiatives and interventions to improve the quality of care for women with breast cancer in the community.