Habermann Elizabeth B, Virnig Beth A, Durham Sara B, Baxter Nancy N
Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455, USA.
Am J Manag Care. 2008 Aug;14(8):514-20.
To assess whether managed care enrollment or healthcare utilization level among women enrolled in Medicare because of disability affects stage at diagnosis and treatment of breast cancer.
Retrospective study using the Surveillance, Epidemiology, and End Results-Medicare database. We compared breast cancer stage at diagnosis and treatment among women with disabilities enrolled in Medicare managed care versus fee-for-service (FFS) Medicare. Women enrolled in FFS Medicare were classified into levels of healthcare utilization during the 6 to 18 months before breast cancer diagnosis.
Controlling for confounders, we used regression models to determine the effects of managed care enrollment and healthcare utilization level on earlier stage at diagnosis and treatment of breast cancer.
Disabled patients enrolled in FFS Medicare without contact with the healthcare system and those with fewer than 12 physician visits during the 6 to 18 months before breast cancer diagnosis were more likely than disabled patients enrolled in Medicare managed care to be diagnosed as having breast cancer at a late stage. There was no difference between women enrolled in Medicare managed care versus women enrolled in FFS Medicare having at least 12 physician visits during the 12-month period. Breast cancer treatment for women with disabilities did not vary across managed care enrollment or healthcare utilization level.
Managed care enrollment or increased contact with healthcare providers could result in earlier stage at breast cancer diagnosis.
评估因残疾而加入医疗保险的女性中，管理式医疗参保情况或医疗保健利用水平是否会影响乳腺癌的诊断阶段和治疗情况。
使用监测、流行病学和最终结果-医疗保险数据库进行回顾性研究。我们比较了加入医疗保险管理式医疗的残疾女性与按服务收费（FFS）医疗保险的残疾女性在乳腺癌诊断和治疗时的分期情况。将加入FFS医疗保险的女性在乳腺癌诊断前6至18个月期间的医疗保健利用水平进行分类。
在控制混杂因素的情况下，我们使用回归模型来确定管理式医疗参保情况和医疗保健利用水平对乳腺癌早期诊断和治疗的影响。
在乳腺癌诊断前6至18个月期间未与医疗保健系统接触且看医生次数少于12次的加入FFS医疗保险的残疾患者，比加入医疗保险管理式医疗的残疾患者更有可能在晚期被诊断出患有乳腺癌。在12个月期间看医生至少12次的加入医疗保险管理式医疗的女性与加入FFS医疗保险的女性之间没有差异。残疾女性的乳腺癌治疗在管理式医疗参保情况或医疗保健利用水平方面没有差异。
加入管理式医疗或增加与医疗保健提供者的接触可能会导致乳腺癌更早被诊断。
