Management of breast cancer in the Medicaid population

Breast cancer is the second most comcancer and the second leading cause of cancer-related death among women. The current project examined some key issues important for effective breast cancer management in the Medicaid population. Medicaid is one the largest healthcare insurance systems in the US providing coverage to more than 60 million low-income individuals. As a part of this project, three studies were conducted. The first study determined the healthcare burden associated with breast cancer in the form of healthcare use (inpatient, outpatient, and emergency room [ER] visits) and costs associated with the condition in the Medicaid population. Significant healthcare burden was observed as the all-cause inpatient, outpatient, and ER visits and the total all-cause costs were found to be significantly higher among women with breast cancer as compared to women without breast cancer. The second study determined the impact of pre-existing mental illness on guideline-consistent breast cancer treatment and breast cancer-related healthcare use among Medicaid enrollees diagnosed with breast cancer. Negative association was observed between pre-existing mental illness and guideline-consistent breast cancer treatment and breast cancer-related outpatient visits indicating treatment disparities among women with breast cancer with pre-existing mental illnesses. The third study determined factors associated with repeat mammography screening in the Medicaid population. Recipient characteristics including age, race, number of outpatient visits during the study period, number of emergency room visits during the study period, use of hormone replacement therapy, and routine cervical cancer screening significantly impacted receipt of repeat mammography screening. The findings of this project could be useful to Medicaid program planners in designing strategies aimed at reducing disparities in breast cancer-related healthcare in the Medicaid population

Patterns of Lung Cancer Care and Associated Health Outcomes Among Elderly Medicare Fee For Service Beneficiaries in West Virginia and in the United States

The elderly carry a disproportionate burden of lung cancer in the US. Although significant improvements have been made during the past decade in cancer treatment, substantial disparities still exist in guideline-based lung cancer care and outcomes. Such variation in lung cancer care is a cause for major concern in rural areas like West Virginia (WV). The purpose of this study was to do a comprehensive evaluation of variations in lung cancer care and associated health outcomes in the elderly. This retrospective study was conducted using SEER-Medicare and WVCR--Medicare linked data files for the years 2002-2007. As part of the project, three studies were conducted. In the first study, we compared geographic variations in clinical guideline-based lung cancer care and associated health outcomes among elderly Medicare Fee-for-service (FFS) beneficiaries. The study found disparities in receipt of minimally appropriate care in both the WV and US populations. Receipt of minimally appropriate care was found to be associated with longer survival times. In the second study, we compared geographic variations in timeliness of lung cancer care and found significant variation in delays in diagnosis and treatment in both the WV and US populations. However, non-timely care was not associated with poorer prognosis. The third study determined the patterns of receipt of tobacco-use cessation counseling services and found such services to be received by more than half of all beneficiaries. Overall, the findings highlight the critical need to address disparities in receipt of guideline-based appropriate and timely lung cancer care among Medicare FFS beneficiaries. The findings also reveals the urgent need for future cancer prevention efforts directed towards promoting smoking cessation in the rural WV population. In the long run, such cancer prevention efforts can help to reduce lung cancer incidence, which in turn can help to reduce the geographic disparities in lung cancer mortality

Measuring access to effective care among elderly medicare enrollees in managed and fee-for-service care: a retrospective cohort study

BACKGROUND: Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care. METHODS: We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets and 2) Medicare claims files for the time period 1994–95. All subjects were Medicare enrollees in a defined area of New England: those enrolled in two divisions of a managed care plan with different physician payment arrangements: a staff model, and a group model; and the Medicare FFS population. We abstracted information on indicators covering several domains: preventive, diagnosis-specific, and chronic disease care. RESULTS: On the indicators we created and tested, access in the single managed care plan under study was comparable to or better than FFS care in the same geographic region. Percent of Medicare recipients with breast cancer screening was 36 percentage points higher in the staff model versus FFS (95% confidence interval 34–38 percentage points). Follow up after hospitalization for myocardial infarction was 20 percentage points higher in the group model than in FFS (95% confidence interval 14–26 percentage points). CONCLUSION: According to indicators developed for use in both claims and automated medical record data, access to care for elderly Medicare beneficiaries in one large managed care organization was as good as or better than that in FFS care in the same geographic area

The Impact of Diffuse Large B-Cell Lymphoma on Primary Care and Costs of Chronic Conditions in Elderly Medicare Beneficiaries

Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive form of Non-Hodgkin\u27s lymphoma with a median age of diagnosis of 67 years. The intensive treatment of DLBCL can negatively influence elderly patients\u27 preventive and chronic care, which can increase the costs of different chronic conditions. DLBCL diagnosis and treatment can affect patients\u27 visits to their primary care providers (PCPs) and other specialists, which are important for patients\u27 preventive screenings and chronic care. Further, having DLBCL increases the risk for breast cancer, and DLBCL treatment is associated with cardiotoxicity and increases the risk of osteoporosis and fractures. Thus, mammography and bone mineral density testing (BDT) are critical areas of screening for individuals with DLBCL, and a change in visits to PCPs can affect preventive and chronic care. Along with these challenges to care quality in DLBCL patients, the costs of different chronic conditions may increase. Currently, there is a dearth of studies that have examined visits to PCPs and specialists, preventive screenings, and costs of chronic conditions among DLBCL patients as compared to individuals with no cancer. We conducted this study to reduce this knowledge gap and to provide actionable strategies to improve the preventive care and reduce the costs of DLBCL patients. The three specific aims of this study were to: 1) analyze the impact of DLBCL on visits to PCPs and specialists over a three-year period of DLBCL diagnosis, treatment, and follow-up; 2) examine the receipt of mammography and BDT by female DLBCL patients during two years after DLBCL diagnosis; and 3) examine the costs of common chronic conditions and total cost over a three-year period of DLBCL diagnosis, treatment, and follow-up among fee-for-service elderly Medicare beneficiaries with newly diagnosed DLBCL as compared to Medicare beneficiaries without cancer. (Abstract shortened by ProQuest.)

Managed Care for Elderly People: A Compendium of Findings

Although managed care seems to serve well the in terests of non-elderly enrollees and their payers, elderly people face more risks. Chronic conditions, multiple prob lems, and more limited resources make them more vul nerable, whereas multiple payer sources make them more complicated to cover. This synthesis of managed care de livered in Medicare and Medicaid demonstration projects serving elderly beneficiaries shows that managed care plans either select or attract enrollees who suffer fewer frailties than those served in fee-for-service settings, ex hibit reluctance to enter rural markets, provide a broad range of elderly-specific services, offer more compre hensive coverage and services, and result in greater per ceived access problems, particularly for vulnerable subgroups. Plans operate more cheaply by using fewer resources, even after adjusting for case mix differences. Managed care enrollees tend to be more satisfied with financial and coverage aspects, whereas fee-for-service enrollees report higher satisfaction on other dimensions. In acute care settings, process of care findings were mixed, whereas clinical and self-reported outcome indi cators were no better and in some instances worse in managed care. Long-term care enrollees, in the few stud ies reported, consistently faired worse in both the processes and outcomes of care. These findings suggest that further research on the effects of managed care in its rapidly changing incarnations is needed, particularly with respect to how to improve the quality of acute and long-term care delivered to elderly people and the proper role of government and other key actors in the health care system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66514/2/10.1177_106286069801300304.pd

Impact of Chronic Conditions on Treatment, Cancer-and Non-Cancer Outcomes among Elderly Men with Incident Prostate Cancer

Prostate Cancer is the most commonly observed non-skin cancer among the elderly men aged 65 years and older in the United States. Nearly one third of elderly men diagnosed with incident prostate cancer have pre-existing chronic conditions. Therefore, among elderly men with prostate cancer, management for cancer and chronic conditions should be optimized to improve healthcare outcomes. Previous literature majorly focused on the risk and management of cancer in the presence of number of conditions, although, it is known that more than 70% of chronic conditions among men diagnosed with prostate cancer were either cardio-metabolic, respiratory or mental health conditions. Lack of evidence persists regarding the impact of common types of chronic conditions and their conditions among elderly men with prostate cancer and vice-versa. The current study is an attempt to shrink the knowledge gap to provide actionable strategies to better management of chronic conditions and prostate cancer among elderly men. The three specific aims of the study were to: (1) examine the associations between the types of pre-existing chronic conditions and cancer stage at diagnosis, initial cancer treatment and clinical outcomes after initial cancer treatment; 2) examine the relationship between metformin use and cancer stage at diagnosis, and the initial cancer-treatment; 3) analyze the impact of cancer diagnosis on the risk of non-cancer hospitalizations and evaluate whether the impact of cancer diagnosis on the risk of non-cancer hospitalizations vary by the types of pre-existing chronic conditions among fee-for-service elderly Medicare beneficiaries with incident prostate cancer. The study used a retrospective cohort design, using multiple years (2002-2010) of the cancer registry data from the Surveillance, Epidemiology and End Results (SEER) program linked with the Medicare administrative claims data and the Area Health Resource Files (AHRF). In the first aim, among elderly men with incident prostate cancer (N = 103,820), the cardio-vascular conditions were the most common chronic condition. 1 in 10 elderly men had advanced prostate cancer at diagnosis. Elderly men without cardio-metabolic, respiratory or mental health conditions were more likely to be diagnosed with advanced prostate cancer as compared to those with all the three types of chronic conditions. 3 in 4 elderly men with localized prostate cancer received either radical prostatectomy (RP), radiation therapy (RT) or hormone therapy during the first six-month after cancer diagnosis. As compared to all three types of chronic conditions, those with single types of chronic conditions were less likely to develop bowel, and urinary dysfunctions. In the second aim, the use of metformin was associated with a reduction in the risk of advanced prostate cancer among elderly men diagnosed with prostate cancer and pre-existing diabetes (N=2, 652). In the third study, elderly men diagnosed with prostate cancer had an increase in the risk of non-cancer hospitalizations during the post-cancer period as compared to the pre-cancer period in both unadjusted and adjusted analyses. The highest rates of non-cancer hospitalizations were observed during first four months after the diagnosis of prostate cancer. To summarize, our study confirms that elderly men with incident prostate cancer and multiple types of pre-existing chronic conditions would pose a different degree of risk for the development of advanced prostate cancer. Although the management of chronic conditions such diabetes with metformin may reduce the risk of advanced prostate cancer among elderly men. An overuse of RT/RP in men with different types of chronic conditions and an increase in the non-cancer hospitalizations in the initial period after diagnosis of prostate cancer suggest the scope of optimum use of RT and RP and improvement in the care of chronic conditions

Using Large Institutional or National Databases to Evaluate Prostate Cancer Outcomes and Patterns of Care: Possibilities and Limitations

Prostate cancer is the most common non–skin-related cancer in men. With advances in technology, the care and treatment for men with this disease continues to become more complex. Large databases offer researchers a unique opportunity to conduct prostate cancer research in various areas, and provide important information that helps patients and providers determine prognosis after treatment. Furthermore, the studies using these databases may provide information on how side effects from various treatments can affect one's quality of life. Finally, information from these datasets can help to identify factors that determine why patients receive the treatments they do. Despite this, these databases are not without limitations. In this review, we discuss various available, national, multicenter, and institutional databases in the context of prostate cancer research, citing numerous important studies that have impacted on our understanding of prostate cancer outcomes

The implications of baseline bone‐health assessment at initiation of androgen‐deprivation therapy for prostate cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142891/1/bju14075.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142891/2/bju14075_am.pd