BREAST CANCER OUTCOMES IN A DOUBLY DISADVANTAGED POPULATION: MEDICAID BENEFICIARI

双重弱势群体的乳腺癌结果：医疗补助受益人

• 批准号: 7679537
• 负责人: SIRAN M. KOROUKIAN
• 金额: $ 5.53万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679537
• 关键词: Adjuvant; Age; Attention; Awareness; Bipolar Disorder; Breast Cancer Detection; Breast Cancer Treatment; Cancer Patient; Caring; Case Management; Chronic; Chronic Disease; Communities; Comorbidity; County; Data; Data Analyses; Diagnosis; Diagnostic Neoplasm Staging; Disadvantaged; Disseminated Malignant Neoplasm; Early Diagnosis; Early treatment; Enrollment; Evaluation; Face; Female Breast Carcinoma; Guidelines; Health Personnel; Health Services; Health Services Accessibility; Health Services Needs; High Prevalence; Incidence; Individual; Intervention; Length; Link; Literature; Major Depressive Disorder; Malignant Neoplasms; Mammography; Marital Status; Medicaid; Medical; Mental disorders; Morbidity - disease rate; Ohio; Outcome; Outcome Measure; Patients; Pattern; Population; Prevention; Process; Race; Recommendation; Relative (related person); Research; Schizophrenia; Screening procedure; Services; Socioeconomic Status; Stage at Diagnosis; Staging; Subgroup; Substance abuse problem; System; Woman; beneficiary; cancer prevention; design; follow-up; health care service utilization; improved; malignant breast neoplasm; mortality; patient population; programs; residence

DESCRIPTION (provided by applicant): Individuals with mental illness (MI), suffering from such conditions as schizophrenia, bipolar disorder, major depression, and/or substance abuse, may also present with chronic medical conditions. Yet our understanding of their use of non-psychiatric health services is very limited. MI patients face numerous barriers to access and adequately utilize health services, including - but not encompassing - financial barriers, and difficulties understanding and being compliant with medical recommendation or treatment. Additionally, given the priority assigned to the management of psychiatric conditions, medical conditions may receive lesser attention in MI than in non-MI patients. Consequently, MI patients are likely to under use much needed health services, resulting in poor prevention and management of chronic diseases and greater morbidity and mortality than that observed in non-MI patients. This is particularly true of cancer, because early detection and receipt of adequate treatment and follow-up care are some of the most important determinants of cancer outcomes. Despite these important differences in patterns of health services utilization, and potential outcomes, MI patients have seldom been identified as a vulnerable subgroup of the population in the disparities literature. The proposed studies will describe patterns of breast cancer screening, diagnosis, treatment, and surveillance in MI and non-MI populations in Ohio, through secondary data analysis. We will focus on female breast cancer because of its high prevalence, and its amenability to screening. Given the significant representation of MI patients in the Medicaid population, we will be using state Medicaid data linked with the Ohio Cancer Incidence Surveillance System (OCISS). First, we will compare receipt of mammography by Medicaid-insured women between those with and without MI. Next, among those diagnosed with incident breast cancer, we will determine whether MI is associated with a) breast cancer stage at presentation; b) receipt of definitive primary and adjuvant treatment in early breast cancer patients; and c) receipt of guideline surveillance after initial treatment for non-metastatic breast cancer. By limiting our studies to Medicaid beneficiaries, we will be able to compare outcomes between MI and non-MI patients who share comparable socio-economic status and various other types of barriers in accessing care. The proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this doubly disadvantaged patient population. As well, these studies will raise awareness in the health care provider and research communities relative to the vulnerabilities associated with MI status, and the importance of special considerations in the design of case management programs for MI patients. Medicaid beneficiaries with mental illness represent a doubly disadvantaged population, given the vulnerabilities associated with each of Medicaid status and mental illness, yet studies relevant to this population have been absent from the disparities literature. By comparing female breast cancer-related care process and outcome measures among Medicaid-insured women between those with and without mental illness, the proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this patient population.

描述(由申请人提供)：患有精神疾病(MI)、患有精神分裂症、双相情感障碍、严重抑郁症和/或药物滥用的个人，也可能出现慢性疾病。然而，我们对他们使用非精神卫生服务的了解非常有限。心肌梗死患者在获得和充分利用医疗服务方面面临许多障碍，包括--但不包括--经济障碍，以及理解和遵守医疗建议或治疗的困难。此外，考虑到精神疾病的优先管理，心肌梗死患者的医疗状况可能比非心肌梗死患者受到的关注较少。因此，与非心肌梗塞患者相比，心肌梗塞患者很可能得不到急需的医疗服务，导致慢性病的预防和管理不力，发病率和死亡率更高。癌症尤其如此，因为及早发现并接受适当的治疗和后续护理是癌症预后的一些最重要的决定因素。尽管在医疗服务利用模式和潜在结果方面存在这些重要差异，但在差异文献中，心肌梗死患者很少被确定为人口中的一个脆弱亚群。建议的研究将通过二次数据分析，描述俄亥俄州MI和非MI人群中乳腺癌筛查、诊断、治疗和监测的模式。我们将把重点放在女性乳腺癌上，因为它的发病率很高，而且适合进行筛查。鉴于心肌梗死患者在医疗补助人口中的重要代表性，我们将使用与俄亥俄州癌症发病率监测系统(OCISS)相关联的州医疗补助数据。首先，我们将比较有医疗补助保险的妇女和没有心肌梗塞的妇女接受乳房X光检查的情况。下一步，对于被诊断为偶发乳腺癌的患者，我们将确定MI是否与a)乳腺癌分期有关；b)早期乳腺癌患者接受明确的初级和辅助治疗；以及c)非转移性乳腺癌患者接受初步治疗后接受指南监测。通过将我们的研究限于医疗补助受益人，我们将能够比较心肌梗死患者和非心肌梗死患者之间的结果，这些患者具有相似的社会经济地位，并在获得医疗保健方面存在各种其他类型的障碍。拟议的研究将为更详细的评估铺平道路，旨在确定阻碍MI患者充分利用医疗服务的具体因素，并开发干预措施，以改进这一双重弱势患者群体的癌症预防和控制战略。此外，这些研究将提高医疗保健提供者和研究社区对与心肌梗死状态相关的脆弱性的认识，以及在为心肌梗死患者设计病例管理计划时特别考虑的重要性。鉴于与医疗补助状况和精神疾病相关的脆弱性，患有精神疾病的医疗补助受益人代表着双重弱势群体，但与这一群体相关的研究一直没有出现在差异文献中。通过比较患有和不患有精神疾病的参加医疗补助的女性中与乳腺癌相关的护理过程和结果指标，拟议的研究将为更详细的评估铺平道路，旨在确定阻碍MI患者充分利用医疗服务的具体因素，并开发干预措施，以改进这一患者群体的癌症预防和控制战略。