Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E342, Bethesda, MD 20892-9762, United States.
J Geriatr Oncol. 2024 Apr;15(3):101748. doi: 10.1016/j.jgo.2024.101748. Epub 2024 Mar 16.
This study aimed to evaluate the association of race/ethnicity and patient care experiences (PCEs) with healthcare utilization and costs among US older adults with prostate cancer (PCa).
The study used data from 2007 to 2015 Surveillance, Epidemiology, and End Results dataset linked to Medicare Consumer Assessment of Healthcare Providers and Systems survey and Medicare claims (SEER-CAHPS). We identified males aged ≥65 years who completed a CAHPS survey within 6-60 months post-PCa diagnosis. Covariate-adjusted associations of six CAHPS PCE composite measures with any emergency department visit and any inpatient stay (using logistic regressions), and with total part A and part B Medicare costs (using generalized linear models) were examined by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, and other).
Among 1834 PCa survivors, a 1-point higher score for getting care quickly was associated with higher odds (odds ratio 1.08; 95% confidence interval [CI]: 1.02-1.15; p = 0.009) of any inpatient stay in Hispanic patients. Higher total costs were associated with a 1-point higher score for getting needed care among Hispanic patients ($590.84; 95% CI: $262.15, $919.53; p < 0.001); a 1-point higher score for getting care quickly among Hispanic patients ($405.26; 95% CI: $215.83, $594.69; p < 0.001); and a 1-point higher score for customer service among patients belonging to other races ($361.69; 95% CI: $15.68, $707.69; p = 0.04).
We observed differential associations by race/ethnicity between PCEs and healthcare utilization and costs. Further research is needed to explore the causes of these associations.
本研究旨在评估种族/民族和患者护理体验（PCEs）与美国老年前列腺癌（PCa）患者的医疗保健利用和成本之间的关联。
本研究使用了 2007 年至 2015 年监测、流行病学和最终结果（SEER）数据集的数据，这些数据与医疗保险消费者评估医疗保健提供者和系统调查以及医疗保险索赔（SEER-CAHPS）相关联。我们确定了在 PCa 诊断后 6-60 个月内完成 CAHPS 调查的年龄≥65 岁的男性。通过种族/民族（非西班牙裔白人、非西班牙裔黑人、西班牙裔、非西班牙裔亚洲人和其他），使用逻辑回归检查了六个 CAHPS PCE 综合措施与任何急诊就诊和任何住院治疗（使用广义线性模型）之间的协变量调整关联，以及与总 A 部分和 B 部分医疗保险费用（使用广义线性模型）之间的关联。
在 1834 名 PCa 幸存者中，护理速度快 1 分与西班牙裔患者任何住院治疗的可能性增加相关（比值比 1.08；95%置信区间[CI]：1.02-1.15；p=0.009）。在西班牙裔患者中，获得所需护理的评分每增加 1 分，总费用就会增加 590.84 美元（95%CI：262.15 美元，919.53 美元；p<0.001）；护理速度快 1 分，西班牙裔患者的费用为 405.26 美元（95%CI：215.83 美元，594.69 美元；p<0.001）；客户服务评分提高 1 分，其他种族患者的费用为 361.69 美元（95%CI：15.68 美元，707.69 美元；p=0.04）。
我们观察到 PCEs 与医疗保健利用和成本之间的种族/民族差异关联。需要进一步研究以探讨这些关联的原因。
