Ted A Skolarus1, Yun Zhang, Brent K Hollenbeck. 1. Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA. tskolar@med.umich.edu
Abstract
BACKGROUND: Cancer survivors are particularly prone to the effects of a fragmented health care delivery system. The implications of fragmented cancer care across providers likely include greater spending and worse quality of care. For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors. METHODS: A total of 67,736 patients diagnosed with prostate cancer between 1992 and 2005 were identified using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Using the Herfindahl-Hirschman Index and a measure of the average number of prostate cancer providers over time, patients were sorted into 3 fragmentation groups (low, intermediate, and high). The authors then examined annual per capita survivorship expenditures and a measure of quality (ie, repetitive prostate-specific antigen [PSA] testing within 30 days) according to their fragmentation exposure using multinomial logistic regression. RESULTS: Patients with highly fragmented cancer care tended to be younger, white, and of higher socioeconomic status (all P < .001). Prostate cancer survivorship interventions were most common among patients with the highest fragmentation of care across providers (P < .001). After adjustment for clinical characteristics and prostate cancer survivorship interventions, higher degrees of fragmentation continued to be associated with repetitive PSA testing (13.6% for high vs 7.0% for low fragmentation; P < .001) and greater spending, particularly among patients not treated with androgen deprivation therapy. CONCLUSIONS: Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors.
BACKGROUND:Cancer survivors are particularly prone to the effects of a fragmented health care delivery system. The implications of fragmented cancer care across providers likely include greater spending and worse quality of care. For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors. METHODS: A total of 67,736 patients diagnosed with prostate cancer between 1992 and 2005 were identified using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Using the Herfindahl-Hirschman Index and a measure of the average number of prostate cancer providers over time, patients were sorted into 3 fragmentation groups (low, intermediate, and high). The authors then examined annual per capita survivorship expenditures and a measure of quality (ie, repetitive prostate-specific antigen [PSA] testing within 30 days) according to their fragmentation exposure using multinomial logistic regression. RESULTS:Patients with highly fragmented cancer care tended to be younger, white, and of higher socioeconomic status (all P < .001). Prostate cancer survivorship interventions were most common among patients with the highest fragmentation of care across providers (P < .001). After adjustment for clinical characteristics and prostate cancer survivorship interventions, higher degrees of fragmentation continued to be associated with repetitive PSA testing (13.6% for high vs 7.0% for low fragmentation; P < .001) and greater spending, particularly among patients not treated with androgen deprivation therapy. CONCLUSIONS:Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors.
Authors: Kevin D Frick; Claire F Snyder; Robert J Herbert; Amanda L Blackford; Bridget A Neville; Antonio C Wolff; Michael A Carducci; Craig C Earle Journal: J Oncol Pract Date: 2016-05-10 Impact factor: 3.840
Authors: Rochelle R Smits-Seemann; Sapna Kaul; Eduardo R Zamora; Yelena P Wu; Anne C Kirchhoff Journal: J Cancer Surviv Date: 2016-08-31 Impact factor: 4.442
Authors: Rahul Garg; Usha Sambamoorthi; Xi Tan; Soumit K Basu; Treah Haggerty; Kimberly M Kelly Journal: Transl Behav Med Date: 2018-05-23 Impact factor: 3.046
Authors: Tiffany K Weidner; John T Kidwell; David A Etzioni; Lindsey R Sangaralingham; Holly K Van Houten; Dennis Asante; Molly Moore Jeffery; Nilay Shah; Nabil Wasif Journal: J Gastrointest Surg Date: 2018-02-12 Impact factor: 3.452
Authors: Deborah R Kaye; Hye Sung Min; Edward C Norton; Zaojun Ye; Jonathan Li; James M Dupree; Chad Ellimoottil; David C Miller; Lindsey A Herrel Journal: J Oncol Pract Date: 2018-02-13 Impact factor: 3.840
Authors: Simon J Craddock Lee; Mark A Clark; John V Cox; Burton M Needles; Carole Seigel; Bijal A Balasubramanian Journal: J Oncol Pract Date: 2016-10-31 Impact factor: 3.840