Health Service Use in the Elderly with Cancer

描述（由申请人提供）：乳腺癌、结肠直肠癌和前列腺癌等常见癌症类型的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疾病的高质量护理。这个项目将测试是否推荐的临床预防服务和护理质量指南在患癌症的美国老年人和没有患癌症的老年人中得到了同样频繁的满足。我们将研究的服务是(a)流感免疫接种；(b)糖尿病护理质量措施：每年测定血清血红蛋白Alc、血清低密度脂、眼科检查和肾病监测；(c)乳腺癌、结直肠癌和前列腺癌的筛查。我们将研究在监测、流行病学和最终结果(SEER)-医疗保险关联数据库中确定的老年医疗保险按服务收费受益人，这些受益人在1999年或1996年或1997年发生乳腺癌、结直肠癌或前列腺癌。具体来说，我们将：1。比较初始治疗完成后新诊断的癌症患者的推荐护理使用率与5%居住在SEER地区没有癌症的美国老年人的使用率；2. 如果存在足够的统计力量，我们将比较多数人口（非西班牙裔白人）与少数人口群体（非西班牙裔黑人、西班牙裔和亚洲人）的服务使用情况。此外，我们将对诊断为原位癌或局部癌的患者与诊断为局部癌或远处癌的患者进行分层亚组分析。这项研究的结果是，提供者将知道是否需要更加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体提供这些服务。

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.