Objective To compare the quality of care by insurance type in federally-funded community health centers (HC). Method A total of 2,018 diabetes patients, randomly selected from 27 HCs in 17 states in the year 2002, were categorized into six mutually exclusive insurance groups. Quality of diabetes care, using six National Committee for Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS) diabetes processes of care and outcome measures, were compared using multivariate logistic regression analyses. Results Thirty-three percent of patients had no health insurance, 24% had Medicare without Medicaid, 15% Medicaid without Medicare, 7% were Medicare-Medicaid dual eligibles, 14% had private insurance, and 7% had other type of insurance. Those without insurance were least likely to meet the HEDIS quality-of-care measures, and those with Medicaid had quality of care that was very similar to those with no insurance. Conclusion Research is needed to identify the major mediators of differences in quality of care by insurance status in safety-net providers such as HCs, for policy interventions at Medicaid benefit design, and incentive to improve quality of care.

Background: Previous reviews and meta-analyses, which predominantly focused on patients treated before 2000, have reported conflicting evidence about the association between hospital/ surgeon volume and rectal cancer outcomes. Given advances in rectal cancer resection such as total mesorectal excision, it is essential to determine if volume plays a role in rectal cancer outcomes among patients treated since 2000. Objective: Determine if there is an association between hospital/surgeon volume and rectal cancer surgery outcomes among patients treated since 2000.

Background Inflammatory breast cancer (IBC) is a rare and highly aggressive form of primary breast cancer. Little is known regarding risk factors for IBC, specifically the association with socioeconomic position (SEP). Methods The association between breast cancer type (IBC vs. non-IBC) with county-level SEP in the Surveillance, Epidemiology, and End Results database for cases diagnosed from 2000–2007 was examined. County-level SEP characteristics included metropolitan vs. non- metropolitan residence, percent below the poverty level, percent less than high school graduate,and an index combining the poverty and high school variables. IBC and non-IBC age-adjusted incidence rates (IRs) were calculated, stratified on SEP and race/ethnicity. The odds of IBC vs. non-IBC given a particular SEP characteristic, adjusting for age and race/ethnicity, was examined through fitting of hierarchical logistic regression models (HLMs). Results IRs for IBC generally increased as SEP decreased, while the opposite was found for non-IBC. HLM results showed low SEP is associated with higher odds of IBC: Highest (≥ 20%) vs. lowest (<10%) persons below the poverty level Odds Ratio (95% Confidence Interval) = 1.25 (1.09–1.43); Highest (>28.76%) vs. lowest (≤15.99%) persons less than high school graduate = 1.25 (1.10–1.42); Low SEP as measured by poverty-high school index vs. high SEP = 1.26 (1.11–1.44). Conclusion Overall breast cancer has been found to be positively associated with SEP, whereas in this analysis IBC was associated with decreasing SEP. Impact Studies focused on understanding the disparity in IBC incidence, as well as interventions to eliminate these differences are needed.