Comorbid condition care quality in cancer survivors: role of primary care and specialty providers and care coordination
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The purpose of this study is to investigate provider specialty, care coordination, and cancer survivors’ comorbid condition care.
This retrospective cross-sectional Surveillance, Epidemiology, and End Results (SEER)-Medicare study included cancer survivors diagnosed in 2004, 2–3 years post-cancer diagnosis, in fee-for-service Medicare. We examined (1) provider specialties (primary care providers (PCPs), oncology specialists, other specialists) visited post-hospitalization, (2) role of provider specialties in chronic and acute condition management, and (3) an ambulatory care coordination measure. Outcome measures covered (1) visits post-hospitalization for nine conditions, (2) chronic disease management (lipid profile, diabetic eye exam, diabetic monitoring), and (3) acute condition management (electrocardiogram (EKG) for congestive heart failure (CHF), imaging for CHF, EKG for transient ischemic attack, cholecystectomy, hip fracture repair).
Among 8661 cancer survivors, patients were more likely to visit PCPs than oncologists or other specialists following hospitalizations for 8/9 conditions. Patients visiting a PCP (vs. not) were more likely to receive recommended care for 3/3 chronic and 1/5 acute condition indicators. Patients visiting a nother specialist (vs. not) were more likely to receive recommended care for 3/3 chronic and 2/5 acute condition indicators. Patients visiting an oncology specialist (vs. not) were more likely to receive recommended care on 2/3 chronic indicators and less likely to receive recommended care on 1/5 acute indicators. Patients at greatest risk for poor coordination were more likely to receive appropriate care on 4/6 indicators.
PCPs are central to cancer survivors’ non-cancer comorbid condition care quality.
Implications for Cancer Survivors
PCP involvement in cancer survivors’ care should be promoted.
KeywordsCancer survivorship Comorbidity Quality of care
The project described was supported by Award Number R01CA149616 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. The findings have been presented in part at the 2012 Annual Meeting of the Society for General Internal Medicine, the 2012 Annual Meeting of the American Society of Clinical Oncology, and the 2012 Biennial Cancer Survivorship Conference. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention, or their contractors and subcontractors are not intended nor should be inferred.
Conflict of interest
Dr. Lemke is a member of a group of faculty and staff at The Johns Hopkins University who develop and maintain the Adjusted Clinical Group (ACG) method. The Johns Hopkins University holds the copyright to the ACG software. To help support research and development, The Johns Hopkins University receives royalties from health plans and other organizations that license the ACG software. Dr. Frick consulted for and sits on a medical advisory board for eviti, a company that provides a service to determine whether a recommended cancer treatment regiment is consistent with evidence as reported in the literature or other guidelines and is consistent with insurers’ payment plans. No other authors have relevant conflicts of interest to disclose.
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