The Hiram C Polk Jr Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY.
Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY.
J Am Coll Surg. 2018 Apr;226(4):498-504. doi: 10.1016/j.jamcollsurg.2017.12.041. Epub 2018 Feb 12.
In January 2014, Kentucky expanded Medicaid coverage to include all individuals and families with incomes up to 33% above the federal poverty line. This study evaluated the early impact of Medicaid expansion on some aspects of the quality of breast cancer care in Kentucky.
The Kentucky Cancer Registry was queried for all women aged 20 to 64 years diagnosed with breast cancer between 2011 and 2016. Demographic, tumor, and treatment characteristics were assessed for each year during this interval. To evaluate the association between Medicaid expansion and these parameters, these variables, along with quality metrics deriving from said variables, were compared for the years 2011 to 2013 (pre) and the years 2014 to 2016 (post).
Of 13,625 women with breast cancer, 11,915 (59.5%) were diagnosed and treated from 2011 to 2013, and 8,127 (40.5%) were diagnosed and treated from 2014 to 2016. After Medicaid expansion, fewer patients were uninsured (3.7% post vs 1.0% pre) and more were covered by Medicaid (15.9% post vs 10.9% pre) (p < 0.001). There was increased diagnosis of early stage (I and II) breast cancer (p = 0.002) and an increasing proportion of women undergoing breast-conservation therapy (p < 0.001). Time from diagnosis to operation increased (p < 0.001), time from operation to chemotherapy remained unchanged (p = 0.26) and time from operation to radiation decreased (p < 0.001).
The expansion of Kentucky Medicaid in 2014 has been associated with earlier diagnosis and somewhat improved quality of breast cancer care, despite a stable disease incidence. Additional improvements in treatment expediency will require improvements in patient outreach and healthcare infrastructure.
2014 年 1 月，肯塔基州将医疗补助计划的覆盖范围扩大到所有收入在联邦贫困线以上 33%的个人和家庭。本研究评估了医疗补助计划扩大对肯塔基州乳腺癌护理质量某些方面的早期影响。
通过肯塔基州癌症登记处查询了 2011 年至 2016 年间诊断为乳腺癌的所有 20 至 64 岁女性的病例。评估了每年的人口统计学、肿瘤和治疗特征。为了评估医疗补助计划扩大与这些参数之间的关联，将这些变量以及源自这些变量的质量指标与 2011 年至 2013 年（前）和 2014 年至 2016 年（后）的年份进行了比较。
在 13625 名患有乳腺癌的女性中，有 11915 名（59.5%）于 2011 年至 2013 年诊断并接受治疗，有 8127 名（40.5%）于 2014 年至 2016 年诊断并接受治疗。医疗补助计划扩大后，未参保的患者人数减少（3.7%后 vs 1.0%前），而参加医疗补助计划的患者人数增加（15.9%后 vs 10.9%前）（p<0.001）。早期（I 期和 II 期）乳腺癌的诊断有所增加（p=0.002），接受保乳治疗的女性比例也有所增加（p<0.001）。从诊断到手术的时间增加（p<0.001），从手术到化疗的时间保持不变（p=0.26），从手术到放疗的时间减少（p<0.001）。
2014 年肯塔基州医疗补助计划的扩大与乳腺癌护理质量的早期诊断和一定程度的改善有关，尽管疾病发病率保持稳定。要进一步提高治疗及时性，需要改善患者外联和医疗保健基础设施。
