Cancer Care and Outcomes for Disabled Medicare Patients

描述（由申请人提供）：来自监测、流行病学和最终结果（SEER）项目的信息与医疗保险索赔合并，为医疗保险受益人的癌症医疗保健服务模式、成本和结果提供了重要的见解。这些发现实际上只适用于65岁及以上的医疗保险受益人。然而，医疗保险覆盖了500多万65岁以下的残疾人，每年的总费用超过200亿美元，还有数百万65岁以上的人最初是因为残疾而获得医疗保险。尽管人数众多，费用高昂，但患上癌症的残疾医疗保险受益人却很少受到关注。该计划的主要目的是描述老年和年轻残疾医疗保险受益人的癌症诊断、初始治疗、姑息治疗、寿命和医疗保险成本。次要目标是比较残疾人和非残疾人之间的癌症诊断、干预措施、临床和成本结果。该项目将检查四种高频疾病（肺癌、乳腺癌、结肠直肠癌和前列腺癌），并将使用合并的SEER-Medicare数据，这些数据来自1986年至1999年诊断的病例。利用来自SEER的诊断、分期和治疗信息，以及来自Medicare索赔的诊断和程序代码和支付信息，本研究将解决从诊断到生命终结的整个护理过程中的问题。问题包括：残疾人是否比非残疾人在较晚阶段得到诊断；初始治疗是否不同；全因死亡率和癌症特异性死亡率是否不同；家庭护理和临终关怀服务的使用是否不同；保险类型是否重要（按服务收费与管理式医疗）；以及当残疾受益人患上癌症时，医疗保险的额外费用。这项研究将首次提供有关残疾医疗保险受益人的癌症检测、护理、成本和结果的综合信息。这些发现可能表明需要更多关注的领域，例如增加残疾医疗保险接受者的癌症筛查或重新考虑初始治疗策略。

DESCRIPTION (provided by applicant): Information from the Surveillance, Epidemiology, and End Results (SEER) Program merged with Medicare claims offers important insights into patterns of health care services, costs, and outcomes for Medicare beneficiaries with cancer. These findings have virtually exclusively pertained to Medicare recipient age 65 and older. However, Medicare covers more than 5 million disabled persons under age 65, with annual total costs exceeding $20 billion, and millions more, now over age 65, initially received Medicare because of disability. Despite these large numbers and high costs, disabled Medicare beneficiaries who develop cancer have received little attention. The primary purpose of the proposed project is to describe cancer diagnoses, initial treatments, palliative care, longevity, and costs to Medicare among older and younger Medicare beneficiaries with disabilities. Secondary goals are to compare cancer diagnoses, interventions, and clinical and cost outcomes between persons with and without disabilities. The project will examine four high-frequency diseases (lung, breast, colorectal, and prostate cancers), and it will use merged SEER-Medicare data from cases diagnosed from 1986 through 1999. Using diagnosis, stage, and treatment information from SEER and diagnosis and procedure codes and payment information from Medicare claims, this study will address questions across the continuum of care, from diagnosis to end of life. Questions include: whether persons with disabilities are diagnosed at later stages than non-disabled persons; whether initial treatments differ; whether all-cause and cancer-specific mortality rates differ; whether use of home care and hospice services differ; whether insurance type matters (fee-for-service versus managed care); and additional costs to Medicare when disabled beneficiaries develop cancer. This study will provide the first comprehensive information on cancer detection, care, costs, and outcomes among disabled Medicare beneficiaries. These findings may suggest areas where more attention is needed, such as increasing cancer screening among disabled Medicare recipients or rethinking initial treatment strategies.