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Kenzik KM, Rocque G, Williams GR, Cherrington A, Bhatia S. Primary care and preventable hospitalizations among Medicare beneficiaries with non-metastatic breast cancer. J Cancer Surviv 2022; 16:853-864. [DOI: 10.1007/s11764-021-01079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
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Namin S, Zhou Y, Neuner J, Beyer K. Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7192. [PMID: 34281129 PMCID: PMC8297243 DOI: 10.3390/ijerph18137192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
Abstract
There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.
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Affiliation(s)
- Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Joan Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Kirsten Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
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Quan D, Luna Wong L, Shallal A, Madan R, Hamdan A, Ahdi H, Daneshvar A, Mahajan M, Nasereldin M, Van Harn M, Opara IN, Zervos M. Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19. J Gen Intern Med 2021; 36:1302-1309. [PMID: 33506402 PMCID: PMC7840076 DOI: 10.1007/s11606-020-06527-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19). OBJECTIVE To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19. DESIGN Retrospective cohort study. SETTING Four hospitals in an integrated health system serving southeast Michigan. PARTICIPANTS Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction. MAIN MEASURES Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment. KEY RESULTS Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531-56,095) vs. $63,317 (49,850-85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001). CONCLUSIONS Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.
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Affiliation(s)
- Daniel Quan
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Anita Shallal
- Department of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Raghav Madan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Abel Hamdan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Heaveen Ahdi
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Amir Daneshvar
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Manasi Mahajan
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - Ijeoma Nnodim Opara
- Department of Internal Medicine, Internal Medicine-Pediatrics Section, Wayne State University School of Medicine, Detroit, MI, USA
| | - Marcus Zervos
- Global Affairs Professor of Medicine, Assistant Dean Wayne State University School of Medicine, MI, Detroit, USA.
- Infectious Diseases, Division Head Henry Ford Health System, MI, Detroit, USA.
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Cheng N, Farley J, Qian J, Zeng P, Chou C, Hansen R. The association of continuity of care and risk of mortality in breast cancer patients with cardiometabolic comorbidities. J Psychosoc Oncol 2021; 40:184-202. [PMID: 33459213 DOI: 10.1080/07347332.2020.1867692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The association of continuity of care (COC) among providers and mortality risk for breast cancer patients with comorbidities is not sufficiently studied. DESIGN A retrospective cohort study using the 2006-2014 Surveillance, Epidemiology and End Results (SEER)-Medicare data. PARTICIPANTS Newly diagnosed female breast cancer patients (n = 57,578) with comorbidities (hypertension, hyperlipidemia, and/or diabetes). METHODS All-cause mortality was assessed annually for up to 5 years. COC was estimated using the Bice-Boxerman index, which included: 1) specialty COC capturing continuity of visits to the same provider type (Primary Care Physicians, Oncologists, and Other specialists) and 2) individual COC capturing continuous care to the same provider regardless of provider specialty. Cox proportional hazards models estimated the hazard ratio (HR) of all-cause mortality across quartile of the COC index. RESULTS Mortality was positively associated with advanced tumor stages and number of comorbidities (p < 0.05). Patients with high specialty COC (4th vs. 1st quartile, HR 1.34, 95%CI 1.29-1.40) had higher risks of mortality compared with those with low specialty COC. However, patients with high individual COC (4th vs. 1st quartile, HR 0.53, 95%CI 0.51-0.54) had lower risks of mortality compared to those with low individual COC. CONCLUSION Receiving care from fewer providers is associated with lower mortality and from fewer types of provider is associated with higher mortality. The results might be confounded by uncontrolled factors and provoke the need for alternative patient care models that recognize the balance between appropriate subspecialties and minimizing the fragmentation of care within and across subspecialties.
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Affiliation(s)
- Ning Cheng
- Department of Biomedical Affair, Edward Via College of Osteopathic Medicine Auburn Campus, Auburn, Alabama, USA
| | - Joel Farley
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jingjing Qian
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
| | - Peng Zeng
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama, USA
| | - Chiahung Chou
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
| | - Richard Hansen
- Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, USA
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Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania-A Geo-Additive Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207526. [PMID: 33081168 PMCID: PMC7588924 DOI: 10.3390/ijerph17207526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007–2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.
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Zahnd WE, McLafferty SL. Contextual effects and cancer outcomes in the United States: a systematic review of characteristics in multilevel analyses. Ann Epidemiol 2017; 27:739-748.e3. [PMID: 29173579 DOI: 10.1016/j.annepidem.2017.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/19/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE There is increasing call for the utilization of multilevel modeling to explore the relationship between place-based contextual effects and cancer outcomes in the United States. To gain a better understanding of how contextual factors are being considered, we performed a systematic review. METHODS We reviewed studies published between January 1, 2002 and December 31, 2016 and assessed the following attributes: (1) contextual considerations such as geographic scale and contextual factors used; (2) methods used to quantify contextual factors; and (3) cancer type and outcomes. We searched PubMed, Scopus, and Web of Science and initially identified 1060 studies. One hundred twenty-two studies remained after exclusions. RESULTS Most studies utilized a two-level structure; census tracts were the most commonly used geographic scale. Socioeconomic factors, health care access, racial/ethnic factors, and rural-urban status were the most common contextual factors addressed in multilevel models. Breast and colorectal cancers were the most common cancer types, and screening and staging were the most common outcomes assessed in these studies. CONCLUSIONS Opportunities for future research include deriving contextual factors using more rigorous approaches, considering cross-classified structures and cross-level interactions, and using multilevel modeling to explore understudied cancers and outcomes.
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Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL; Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL.
| | - Sara L McLafferty
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, Urbana, IL
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Rabin BA, Ellis JL, Steiner JF, Nekhlyudov L, Feuer EJ, Hankey BF, Cynkin L, Bayliss E. Health-care utilization by prognosis profile in a managed care setting: using the Surveillance, Epidemiology and End Results Cancer Survival Calculator SEER*CSC. J Natl Cancer Inst Monogr 2015; 2014:275-81. [PMID: 25417241 DOI: 10.1093/jncimonographs/lgu023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Accurate estimation of the probability of dying of cancer versus other causes is needed to inform goals of care for cancer patients. Further, prognosis may also influence health-care utilization. This paper describes health service utilization patterns of subgroups of prostate cancer and colorectal cancer (CRC) patients with different relative probabilities of dying of their cancer or other conditions. METHODS A retrospective cohort of cancer patients from Kaiser Permanente Colorado were divided into three groups using the predicted probabilities of dying of cancer and other causes calculated by the nomograms in the National Cancer Institute Surveillance, Epidemiology and End Results Cancer Survival Calculator. Demographic, disease-related characteristics, and health service utilization patterns were described across subgroups. RESULTS The cohort consisted of 2092 patients (1102 prostate cancer and 990 CRC). A new diagnosis of cancer increased utilization of cancer-related services with rates as high as 9.1/1000 person-days for prostate cancer and 36.2/1000 person-days for CRC. Little change was observed in the number of primary and other specialty care visits from prediagnosis to 1 and 2 years postdiagnosis. CONCLUSIONS We found that although a new diagnosis of cancer increased utilization of cancer-related services for an extended time period, the timing of cancer diagnosis did not appear to affect other types of utilization. Future research should assess the reason for the lack of impact of cancer and unrelated comorbid conditions on utilization and whether desired outcomes of care were achieved.
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Affiliation(s)
- Borsika A Rabin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC).
| | - Jennifer L Ellis
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - John F Steiner
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Larissa Nekhlyudov
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Eric J Feuer
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Benjamin F Hankey
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Laurie Cynkin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
| | - Elizabeth Bayliss
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, Denver, CO (BAR); Cancer Research Network Cancer Communication Research Center (BAR), Institute for Health Research (JLE, JFS, EB), Kaiser Permanente Colorado, Denver, CO; Department of Population Medicine, Harvard Medical School, Boston, MA, Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA (JN); Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, BFH, LC)
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Niccolai LM, Julian PJ, Meek JI, Hadler JL, Sosa L. Niccolai et al. Respond. Am J Public Health 2013; 103:e4-5. [DOI: 10.2105/ajph.2013.301498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Linda M. Niccolai
- Linda M. Niccolai, Pamela J. Julian, James I. Meek, and James L. Hadler are with the Yale School of Public Health and the Connecticut Emerging Infections Program, New Haven. Lynn Sosa is with the Connecticut Department of Public Health, Hartford
| | - Pamela J. Julian
- Linda M. Niccolai, Pamela J. Julian, James I. Meek, and James L. Hadler are with the Yale School of Public Health and the Connecticut Emerging Infections Program, New Haven. Lynn Sosa is with the Connecticut Department of Public Health, Hartford
| | - James I. Meek
- Linda M. Niccolai, Pamela J. Julian, James I. Meek, and James L. Hadler are with the Yale School of Public Health and the Connecticut Emerging Infections Program, New Haven. Lynn Sosa is with the Connecticut Department of Public Health, Hartford
| | - James L. Hadler
- Linda M. Niccolai, Pamela J. Julian, James I. Meek, and James L. Hadler are with the Yale School of Public Health and the Connecticut Emerging Infections Program, New Haven. Lynn Sosa is with the Connecticut Department of Public Health, Hartford
| | - Lynn Sosa
- Linda M. Niccolai, Pamela J. Julian, James I. Meek, and James L. Hadler are with the Yale School of Public Health and the Connecticut Emerging Infections Program, New Haven. Lynn Sosa is with the Connecticut Department of Public Health, Hartford
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Schulman KL, Berenson K, Tina Shih YC, Foley KA, Ganguli A, de Souza J, Yaghmour NA, Shteynshlyuger A. A checklist for ascertaining study cohorts in oncology health services research using secondary data: report of the ISPOR oncology good outcomes research practices working group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:655-669. [PMID: 23796301 DOI: 10.1016/j.jval.2013.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The ISPOR Oncology Special Interest Group formed a working group at the end of 2010 to develop standards for conducting oncology health services research using secondary data. The first mission of the group was to develop a checklist focused on issues specific to selection of a sample of oncology patients using a secondary data source. METHODS A systematic review of the published literature from 2006 to 2010 was conducted to characterize the use of secondary data sources in oncology and inform the leadership of the working group prior to the construction of the checklist. A draft checklist was subsequently presented to the ISPOR membership in 2011 with subsequent feedback from the larger Oncology Special Interest Group also incorporated into the final checklist. RESULTS The checklist includes six elements: identification of the cancer to be studied, selection of an appropriate data source, evaluation of the applicability of published algorithms, development of custom algorithms (if needed), validation of the custom algorithm, and reporting and discussions of the ascertainment criteria. The checklist was intended to be applicable to various types of secondary data sources, including cancer registries, claims databases, electronic medical records, and others. CONCLUSIONS This checklist makes two important contributions to oncology health services research. First, it can assist decision makers and reviewers in evaluating the quality of studies using secondary data. Second, it highlights methodological issues to be considered when researchers are constructing a study cohort from a secondary data source.
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Tyo KR, Gurewich D, Shepard DS. Methodological challenges of measuring primary care delivery to pediatric medicaid beneficiaries who use community health centers. Am J Public Health 2012; 103:273-5. [PMID: 23237184 DOI: 10.2105/ajph.2012.300884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Efforts to measure quality of care have focused on ambulatory care providers. We examined the performance of community health centers serving children on Medicaid in 3 states. Descriptive analysis showed considerable patient population heterogeneity, and regression analysis demonstrated that variation explained by the assigned provider was small (mean R(2) = 4.3%) compared with the variation explained by patient demographic variables (mean R(2) = 29.9%). The results reinforce the need for caution when one is attributing quality differences to provider performance.
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Affiliation(s)
- Karen R Tyo
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110, USA
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Treanor C, Donnelly M. An international review of the patterns and determinants of health service utilisation by adult cancer survivors. BMC Health Serv Res 2012; 12:316. [PMID: 22973899 PMCID: PMC3465193 DOI: 10.1186/1472-6963-12-316] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022] Open
Abstract
Background There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services. Methods Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review. Results Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provision s- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors. Conclusions Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.
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Affiliation(s)
- Charlene Treanor
- Cancer Epidemiology & Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK.
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Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study. Cancer Causes Control 2012; 23:1529-40. [PMID: 22833236 DOI: 10.1007/s10552-012-0030-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 07/10/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Female breast cancer survivors, a large and growing population, experience impaired physical functioning after treatment. Survivors living in impoverished neighborhoods may suffer even greater impairment, but the mechanisms linking neighborhood poverty and individual outcomes are poorly understood. This study sought to identify mediators of the effect of neighborhood poverty on physical functioning using longitudinal data from a Missouri cancer registry-based sample of 909 female breast cancer survivors. METHODS Survivors were recruited 1 year after diagnosis (Y1) and completed two telephone interviews, at Y1 and 1 year later (Y2). The association between census-tract-level poverty and physical functioning (RAND SF-36) was tested using a multilevel a priori path model with 19 hypothesized mediators, demographic and socioeconomic confounders, and covariates. Hypothesized mediators included clinical and treatment variables, psychosocial factors (depression, stress, social support), perceived neighborhood characteristics, behavioral risk factors (physical activity, smoking, body mass index, alcohol use), and comorbidity. RESULTS In unadjusted analysis, women living in neighborhoods with higher poverty were more likely to report lower physical functioning at Y2 (β = -.19, p < .001). The final mediated model fit the data well (χ(2)(8) = 12.25, p = 0.14; CFI = .996; RMSEA = .024). The effect of neighborhood poverty on physical functioning was fully mediated by physical activity and body mass index. CONCLUSIONS Breast cancer survivors living in neighborhoods with greater poverty reported lower physical functioning, but this effect was fully explained by physical activity and body mass index. Community-based lifestyle interventions sensitive to the unique challenges faced by cancer survivors and the challenges of living in a high-poverty neighborhood are needed to ameliorate neighborhood socioeconomic disparities in physical functioning.
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Tremblay D, Charlebois K, Terret C, Joannette S, Latreille J. Integrated oncogeriatric approach: a systematic review of the literature using concept analysis. BMJ Open 2012; 2:bmjopen-2012-001483. [PMID: 23220777 PMCID: PMC3533132 DOI: 10.1136/bmjopen-2012-001483] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study was to provide a more precise definition of an integrated oncogeriatric approach (IOGA) through concept analysis. DATA SOURCES The literature was reviewed from January 2005 to April 2011 integrating three broad terms: geriatric oncology, multidisciplinarity and integrated care delivery models. STUDY ELIGIBILITY CRITERIA Citation selection was based on: (1) elderly cancer patients as the study population; (2) disease management and (3) case studies, intervention studies, assessments, evaluations and studies. Inclusion and exclusion criteria were refined in the course of the literature search. INTERVENTIONS Initiatives in geriatric oncology that relate to oncology services, social support services and primary care services for elderly cancer patients. PARTICIPANTS Elderly cancer patients aged 70 years old or more. STUDY APPRAISAL AND SYNTHESIS METHODS Rodgers' concept analysis method was used for this study. The analysis was carried out according to thematic analysis based on the elements of the Chronic Care Model. RESULTS The search identified 618 citations. After in-depth appraisal of 327 potential citations, 62 articles that met our inclusion criteria were included in the analysis. Three IOGA main attributes were identified, which constitute IOGA's core aspects: geriatric assessment (GA), comorbidity burden and treatment outcomes. The IOGA concept comprises two broad antecedents: coordinated healthcare delivery and primary supportive care services. Regarding the consequents of an integrated approach in geriatric oncology, the studies reviewed remain inconclusive. CONCLUSIONS Our study highlights the pioneering character of the multidimensional IOGA concept, for which the relationship between clinical and organisational attributes, on the one hand, and contextual antecedents, on the other, is not well understood. We have yet to ascertain IOGA's consequents. IMPLICATIONS OF KEY FINDINGS: There is clearly a need for a whole-system approach to change that will provide direction for multilevel (clinical, organisational, strategic) interventions to support interdisciplinary practice, education and research.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, École des Sciences infirmières, Longueuil, Québec, Canada
| | - Kathleen Charlebois
- Centre de recherche CSSS Champlain-Charles Le Moyne, Longueuil,Québec, Canada
| | - Catherine Terret
- Programme d'oncologie gériatrie, Département d'oncologie, Centre Leon-Bérard, Claude-Bernard Lyon-1 Université Lyon, Lyon, France
| | - Sonia Joannette
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Jean Latreille
- Centre intégré de cancérologie de la Montérégie, Greenfield Park, Québec,Canada, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Longueuil. Québec, Canada
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