Onega Tracy, Duell Eric J, Shi Xun, Demidenko Eugene, Goodman David
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA.
J Gen Intern Med. 2009 Feb;24(2):205-10. doi: 10.1007/s11606-008-0863-y. Epub 2008 Dec 6.
Geographic access to NCI-Cancer Centers varies by region, race/ethnicity, and place of residence, but utilization of these specialized centers has not been examined at the national level in the U.S. This study identified determinants of NCI-Cancer Center attendance in Medicare cancer patients.
SEER-Medicare (Surveillance Epidemiology and End Results) data were used to identify individuals with an incident cancer of the breast, lung, colon/rectum, or prostate from 1998-2002. NCI-Cancer Center attendance was determined based on utilization claims from 1998-2003. Demographic, clinical, and geographic factors were examined in multilevel models. We performed sensitivity analyses for the NCI-Cancer Center attendance definition.
Overall, 7.3% of this SEER-Medicare cohort (N = 211,048) attended an NCI-Cancer Center. Travel-time to the nearest NCI-Cancer Center was inversely related to attendance, showing 11% decreased likelihood of attendance for every 10 minutes of additional travel-time (OR = 0.89, 95%CI 0.88-0.90). Receiving predominantly generalist care prior to diagnosis was associated with a lower likelihood of attendance (OR = 0.79, 95%CI 0.77-0.82). The other factors associated with greater NCI-Cancer attendance were later stage at diagnosis, fewer comorbidities, and urban residence in conjunction with African-American race.
Attendance at NCI-Cancer Centers is low among Medicare beneficiaries, but is strongly influenced by proximity and general provider care prior to diagnosis. Other patient factors are predictive of NCI-Cancer Center attendance and may be important in better understanding cancer care utilization.
美国国立癌症研究所（NCI）癌症中心的地理可及性因地区、种族/族裔和居住地而异，但这些专业中心的利用情况在美国尚未进行全国层面的研究。本研究确定了医疗保险癌症患者前往NCI癌症中心就诊的决定因素。
利用监测、流行病学和最终结果（SEER）-医疗保险数据，识别出1998年至2002年期间患有乳腺癌、肺癌、结肠/直肠癌或前列腺癌的患者。根据1998年至2003年的利用索赔确定NCI癌症中心的就诊情况。在多水平模型中检查人口统计学、临床和地理因素。我们对NCI癌症中心就诊定义进行了敏感性分析。
总体而言，该SEER-医疗保险队列中的7.3%（N = 211,048）前往NCI癌症中心就诊。到最近的NCI癌症中心的旅行时间与就诊率呈负相关，每增加10分钟旅行时间，就诊可能性降低11%（OR = 0.89，95%CI 0.88 - 0.90）。诊断前主要接受全科医生治疗与就诊可能性较低相关（OR = 0.79，95%CI 0.77 - 0.82）。与更高的NCI癌症就诊率相关的其他因素包括诊断时分期较晚、合并症较少以及城市居住且为非裔美国人种族。
医疗保险受益人中前往NCI癌症中心就诊的比例较低，但受到距离和诊断前一般医疗服务提供者护理的强烈影响。其他患者因素可预测NCI癌症中心的就诊情况，对于更好地理解癌症护理利用情况可能很重要。
