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Health Aff (Millwood). 2018 Mar;37(3):421-428. doi: 10.1377/hlthaff.2017.1045.

Quality Of Breast Cancer Care In The US Territories: Insights From Medicare.

Author information

1
Tracy M. Layne ( tracy.layne@nih.gov ) is a postdoctoral fellow in the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, in Bethesda, Maryland.
2
Jenerius A. Aminawung is a research associate in the Department of Internal Medicine, Yale School of Medicine, in New Haven, Connecticut.
3
Pamela R. Soulos is a program manager and data analyst in the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center and a research associate in the Department of Internal Medicine, both at the Yale School of Medicine.
4
Marcella Nunez-Smith is an associate professor of medicine in the Department of Internal Medicine and director of the Equity Research and Innovation Center, both at the Yale School of Medicine.
5
Maxine A. Nunez is a professor of nursing at the University of the Virgin Islands School of Nursing, in Saint Thomas, and principal investigator, Eastern Caribbean Health Outcomes Research Network, at the Yale Transdisciplinary Collaborative Center in the Yale School of Medicine.
6
Beth A. Jones is a research scientist and lecturer in epidemiology in the Chronic Disease Epidemiology Department, Yale School of Public Health, in New Haven.
7
Karen H. Wang is an instructor in the Department of Internal Medicine, Yale School of Medicine.
8
Cary P. Gross is a professor of medicine in the Department of Internal Medicine, director of COPPER Center, and director of the National Clinician Scholars Program, all at the Yale School of Medicine.

Abstract

The quality of breast cancer care among Medicare beneficiaries in the US territories-where federal spending for health care is lower than in the continental US-is unknown. We compared female Medicare beneficiaries who were residents of the US territories and had surgical treatment for breast cancer in 2008-14 to those in the continental US in terms of receipt of recommended breast cancer care (diagnostic needle biopsy and adjuvant radiation therapy [RT] following breast-conserving surgery) and the timeliness (time from needle biopsy to surgery and from surgery to adjuvant RT) of that care. Residents of the US territories were less likely to receive recommended care (24 percent lower odds of receiving diagnostic needle biopsy and 34 percent lower odds of receiving adjuvant RT) and to receive timely care (45 percent lower odds of receiving surgery and 82 percent lower odds of receiving adjuvant RT, both within three months). Further research is needed to identify barriers to the provision of adequate and timely breast cancer care in this unique population.

KEYWORDS:

Breast cancer; Disparities; Medicare; Quality Of Care; US Territories

PMID:
29505365
DOI:
10.1377/hlthaff.2017.1045

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