Managed care organizations and mammography: opportunities to serve underserved women

Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

How Does Managed Care Improve the Quality of Breast Cancer Care Among Medicare-Insured Minority Women?

PURPOSE

The aim of this study is to investigate if evidence-based clinical guidelines are implemented equitability among ethnic minority breast cancer patients using Medicare Advantage and investigate if presumed advantages of managed care over fee-for-service are greater for minorities than for Whites.

METHODS

Data from the Surveillance, Epidemiology, and End Results and Medicare were used to examine 70,755 women over age 65 diagnosed with early stage breast cancer between 2005 and 2009. Implementation of two clinical guidelines was assessed: receipt of radiation therapy after breast conserving surgery and estrogen receptor status documentation. Multilevel logistic regression and inverse propensity weighting controlled for confounding.

RESULTS

African Americans are still less likely than Whites to receive radiation therapy after breast-conserving surgery, whether they use Medicare fee-for-service (OR 95 % CI) = 0.90 (0.83, 0.98) or managed care (OR 95 % CI) = 0.87 (0.76, 1.00). Differences between receipt of radiation therapy by insurance plan type was nonexistent. Relative to FFS, the use of managed care improved the odds of having estrogen receptor status documented by 44 % in African Americans, (OR 95 % CI) = 1.44 (1.15, 1.83) and by 42 % in Latina patients (OR 95 % CI) = 1.42 (1.17, 1.78).

CONCLUSIONS

Compared to Medicare fee-for-service, ethnic and racial disparities among Medicare Advantage users were reduced. We observed fewer disparities, but not an elimination of disparities, among Medicare Advantage enrollees receiving breast cancer care with an organizational and patient component of care. This suggests managed care may still need to focus on minority patient empowerment and involvement in care.

Community trends in the early detection of breast cancer in Wisconsin, 1980-1998

BACKGROUND

Early detection of breast cancer is an important public health goal. Rates of early detection have increased over the past several decades, contributing to recent declines in mortality. Despite these overall trends, however, some populations have experienced less progress than others.

METHODS

The rates of early detection, measured as the percentage of breast cancers diagnosed as breast carcinoma in situ, were calculated using data from Wisconsin's population-based tumor registry from 1980 to 1998. Trends in breast cancer (percent diagnosed in situ) were examined over time by socioeconomic characteristics of ZIP code of residence, using census data.

RESULTS

The percentage of breast cancer cases that were breast carcinoma in situ was more than five times greater in the later period (1994-1998) (13.9%), compared with the early period (1980-1984) (2.6%). In the middle period (1987-1991), breast cancer was diagnosed as breast carcinoma in situ about one-third less frequently among women in areas with the lowest urbanization, median family income, and percent educated beyond high school, compared with communities with the highest levels of these variables. Recently disparities in early detection rates by community income and education indicators declined slightly, whereas disparities in percent of breast carcinoma in situ by urbanization did not.

CONCLUSIONS

Communities with lower levels of income, education, and urbanization lagged in the early detection of breast cancer during the 1980s and, despite some progress during the 1990s, continue to be underserved. Women in these communities should be targeted for interventions to improve the early detection of breast cancer.

Trends in breast cancer mortality in Asturias, Spain

While breast cancer mortality rates are subsiding or beginning to decline in many western countries, in Spain they are increasing. We have studied breast cancer mortality rates in Asturias (Spain) by using the age-period-cohort model for the period of 1975-1994. There was an increase in the adjusted rates. The increase of relative risk of death in the period 1990-1994, in relation to that in 1975-1979, was 43%. There is a tendency for successive cohorts to have higher age-specific rates than previous cohorts. Trends in breast cancer mortality rates have been driven predominantly by birth cohort rate trends over the last decades in Asturias, suggesting that the changes in breast cancer mortality have been largely influenced by changes in aetiological factors.