Table 15Quality measures used to assess differences in quality of care by patients' socioeconomic status

QuestionQuality measureStudyResults - socioeconomic status (income/insurance status)
2bSurgery rate for colon or rectal cancer patientsRoetzheim et al.94Controlling for demographic, socioeconomic status factors, and clinical risk factors, the uninsured and Medicaid patients were less likely to undergo surgical treatment compared to FFS patients, p < 0.01.
Surgery rateVernon et al.92No statistically significant difference in treatment use of HMO vs. FFS patients when controlling for demographic, clinical, and socioeconomic status factors.
Surgical resection rate of colonMerrill et al.91Controlling for demographic, socioeconomic status, and clinical factors, no difference observed in rectal cancer treatment of HMO vs. FFS patients undergoing surgery. HMO patients with rectal cancer were more likely to receive postsurgical radiation treatment than FFS patients.
2cRate of adjuvant chemotherapy use for stage III colon or stage II, III rectal cancerAyanian et al.127Controlling for demographic, other socioeconomic status, and clinical risk factors, median household income was a predictor of rate of treatment; the higher the income, the more likely receipt of treatment, p = 0.006.
Percentage of patients with stage II or III rectal cancer receiving chemoradiotherapySchrag et al.132A slight, positive relationship (p = 0.09) was found between median income and odds of receiving adjuvant chemoradiation therapy, adjusting for demographic, socioeconomic status, comorbidity, and other clinical risk factors.
Percentage of patients diagnosed with stage III colon cancer who received adjuvant chemotherapySchrag et al.128Adjusting for demographic, comorbidity, and other clinical risk factors, a positive relationship was observed between median household income and receipt of treatment, p = 0.06.
Percent of patients diagnosed with stage II, III rectal cancer receiving adjuvant therapyPotosky et al.125Controlling for demographic, socioeconomic status, and clinical risk factors, income was found to be inversely related to standard adjuvant therapy (chemotherapy for stage III colon and chemotherapy and radiation therapy for stage II, III rectal cancer) use, p < 0.001.
Adjuvant chemotherapy rate for patients with stage III colon cancerKeating et al.130After controlling for age, race, tumor stage and grade, comorbidity, socioeconomic status, and other risk factors, researchers found no statistically significant difference in increased market share penetration associated with lower rates of therapy use.
Adjuvant chemotherapy rate for patients with stage II or III rectal cancerKeating et al.130After controlling for age, race, tumor stage and grade, comorbidity, socioeconomic status, and other risk factors, researchers found increased market share of managed care resulted in significant decrease in percent of patients with stage II or III rectal cancer received adjuvant chemotherapy and radiotherapy.
Chemotherapy rate for patients with colon or rectal cancerRoetzheim et al.94Controlling for demographic, socioeconomic status factors, and clinical risk factors, patients who are members of a community HMO were less likely to receive treatment compared to those participating in a FFS program.
Palliative chemotherapy rateRetchin and Brown136No statistically significant difference between HMO and FFS patients undergoing palliative chemotherapy.
Rate of adjuvant radiation therapy use for stage II, III rectal cancerAyanian et al.127Controlling for demographic, other socioeconomic status, and clinical risk factors, median household income was positively related to receipt of treatment, p = 0.006.
2dRate of radiation therapyRoetzheim et al.94Controlling for demographic and clinical risk factors, lower income level was a predictor of receipt of radiation therapy. Medicare patients enrolled in an HMO with colon cancer were less likely to receive radiation therapy. Among non-Medicare HMO enrollees, no insurance-related differences were observed.
3Rate of complete colonoscopy pre- or perioperativelyKeating et al.130After controlling for age, race, tumor stage and grade, comorbidity, socioeconomic status, and other risk factors, researchers found that increased market share of managed care in a given county resulted in significant increase in the percent of patients with complete colonoscopy pre- or perioperatively, p = 0.001.
Rate of colonoscopy during 7 to 18 mo after diagnosisKeating et al.130After controlling for age, race, tumor stage and grade, comorbidity, socioeconomic status, and other risk factors, researchers found no statistically significant difference in colonoscopy rates and market share increase of managed care.
Rate of colonoscopy or flexible sigmoidoscopy with barium enema after diagnosisRulyak et al.157Controlling for demographic, clinical, socioeconomic status, and site of service covariates, high median household annual income (≥ $40,000) was positively associated with receipt of first complete exam of the colon.
Percentage of patients who received posttreatment colonoscopyLaFata et al.162Adjusting for demographic, socioeconomic status, and clinical risk factors, income was inversely related to receipt of followup colonoscopy (p = 0.03).
Percentage of CRC patients having a surveillance colonoscopy after surgeryRetchin and Brown136No statistically significant difference found between receipt of surveillance colonoscopy and health plan coverage (HMO vs. FFS).

Abbreviations: FFS = fee-for-service; HMO = health maintenance organization

From: 3, Results

Cover of Cancer Care Quality Measures
Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer.
Evidence Reports/Technology Assessments, No. 138.
Patwardhan MB, Samsa GP, McCrory DC, et al.

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