Riley Gerald F, Warren Joan L, Potosky Arnold L, Klabunde Carrie N, Harlan Linda C, Osswald Michael B
Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland 21244, USA.
Med Care. 2008 Oct;46(10):1108-15. doi: 10.1097/MLR.0b013e3181862565.
To compare the Medicare managed care (MC) and fee-for-service (FFS) sectors on stage at diagnosis and treatment patterns for prostate, female breast, and colorectal cancers, and to examine patterns across MC plans.
Surveillance, Epidemiology, and End Results-Medicare linked data.
Among cases diagnosed at ages 65-79 between 1998 and 2002, we selected all MC enrollees (n = 42,467) and beneficiaries in FFS (n = 82,998) who resided in the same counties. MC and FFS samples were compared using logistic regression, adjusting for demographic, geographic, and clinical covariates.
The percentage of late stage cases was similar in MC and FFS for prostate and colorectal cancers; there were slightly fewer late stage breast cancer cases in MC after adjustment (7.3% vs. 8.5%, P < 0.001). Within MC, radical prostatectomy was performed less frequently for clinically localized prostate cancer (18.3% vs. 22.4%, P < 0.0001), and 12 or more lymph nodes were examined less often for resected colon cancer cases (40.9% vs. 43.0%, P < 0.05). Treatment patterns for early stage breast cancer were similar in MC and FFS. Analyses of treatment patterns at the individual plan level revealed significant variation among plans, as well as within the FFS sector, for all 3 types of cancer.
On average, there are few significant differences in cancer diagnosis and treatment between MC and FFS. Such comparisons, however, mask the wide variability among MC plans, as well as FFS providers. Observed variation in patterns of care may be related to patient selection, but can potentially lead to outcome differences. These findings support the need for quality measures to evaluate plan practices and performance.
比较医疗保险管理式医疗（MC）和按服务付费（FFS）部门在前列腺癌、女性乳腺癌和结直肠癌诊断阶段及治疗模式方面的情况，并研究各MC计划之间的模式。
监测、流行病学和最终结果 - 医疗保险关联数据。
在1998年至2002年期间诊断为65 - 79岁的病例中，我们选取了居住在同一县的所有MC参保者（n = 42,467）和FFS受益人群（n = 82,998）。使用逻辑回归对MC和FFS样本进行比较，并对人口统计学、地理和临床协变量进行调整。
前列腺癌和结直肠癌的晚期病例在MC和FFS中的比例相似；调整后，MC中的晚期乳腺癌病例略少（7.3%对8.5%，P < 0.001）。在MC内，临床局限性前列腺癌行根治性前列腺切除术的频率较低（18.3%对22.4%，P < 0.0001），切除的结肠癌病例检查12个或更多淋巴结的频率也较低（40.9%对43.0%，P < 0.05）。早期乳腺癌的治疗模式在MC和FFS中相似。对各计划层面治疗模式的分析显示，对于所有3种癌症，各计划之间以及FFS部门内部均存在显著差异。
平均而言，MC和FFS在癌症诊断和治疗方面几乎没有显著差异。然而，此类比较掩盖了MC计划以及FFS提供者之间的广泛差异。观察到的护理模式差异可能与患者选择有关，但可能导致结果差异。这些发现支持需要采用质量指标来评估计划实践和绩效。
