National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA.
National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA.
J Geriatr Oncol. 2021 Apr;12(3):446-452. doi: 10.1016/j.jgo.2020.09.003. Epub 2020 Sep 15.
Care coordination reflects deliberate efforts to harmonize patient care. This study examined variables associated with patient-reported care coordination scores among Medicare beneficiaries with a history of cancer.
We utilized Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, which includes cancer registry data, patient experience surveys, and Medicare claims. We identified Medicare beneficiaries with a CAHPS survey ≤10 years after cancer diagnosis who reported seeing a personal doctor within six months. Multivariable regression models examined associations between cancer survivor characteristics and patient-reported care coordination, with higher scores indicating better coordination.
Cancer site distribution of the 14,646 survey respondents was 33.7% prostate, 22.1% breast, 11.1% colorectal, 7.2% lung, and 25.9% other. Rural residence at diagnosis (versus urban, 1.1-point difference; p = 0.04) and reporting >4 visits with a personal doctor (versus 1-2 visits, 3.0-point difference; p < 0.001) were significantly associated with higher care coordination. Older age (p < 0.001) and seeing more specialists (p = 0.006) were associated with significantly lower care coordination. Patients with melanoma (women: 5.2-point difference, p < 0.001; men: 2.7 points, p = 0.01) or breast cancer (women: 2.4 points; p < 0.001) reported significantly lower care coordination scores than did men with prostate cancer (reference group). Time from diagnosis to survey, cancer stage, number of cancers, and comorbidities were not significantly associated with care coordination scores.
Cancer site, rural residence, and number of physician interactions are associated with patient-reported care coordination scores. Future research should address multilevel influences that lead to worse care coordination for older adult cancer survivors.
护理协调反映了协调患者护理的精心努力。本研究调查了在有癌症病史的 Medicare 受益人群中，与患者报告的护理协调评分相关的变量。
我们利用了监测、流行病学和最终结果-医疗保健提供者和系统消费者评估（SEER-CAHPS）的链接数据，其中包括癌症登记数据、患者体验调查和 Medicare 索赔。我们确定了在癌症诊断后 ≤10 年内接受 CAHPS 调查且在六个月内看过私人医生的 Medicare 受益人群。多变量回归模型研究了癌症幸存者特征与患者报告的护理协调之间的关联，得分越高表示协调越好。
14646 名调查受访者的癌症部位分布为：前列腺 33.7%、乳房 22.1%、结直肠 11.1%、肺 7.2%、其他 25.9%。诊断时居住在农村（与城市相比，差异为 1.1 分；p=0.04）和报告与私人医生有 >4 次就诊（与 1-2 次就诊相比，差异为 3.0 分；p<0.001）与更高的护理协调显著相关。年龄较大（p<0.001）和看更多专科医生（p=0.006）与护理协调显著降低相关。黑色素瘤患者（女性：5.2 分差异，p<0.001；男性：2.7 分，p=0.01）或乳腺癌患者（女性：2.4 分；p<0.001）报告的护理协调评分明显低于前列腺癌男性（参考组）。从诊断到调查的时间、癌症分期、癌症数量和合并症与护理协调评分无显著相关性。
癌症部位、农村居住和医生就诊次数与患者报告的护理协调评分相关。未来的研究应解决导致老年癌症幸存者护理协调更差的多层次影响。
