Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Abstract

Results suggest that CCNC enrollment is associated with guideline-concordant follow-up care for Medicaid-insured survivors. Given the growing population of cancer survivors and increased emphasis on primary care medical homes, future studies should explore what factors are associated with medical home participation and whether similar findings are observed with extended follow-up.

Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients

“…As we have reported elsewhere [10], breast cancer survivors who were enrolled in CCNC were significantly more likely to receive guideline-concordant follow-up care. By virtue of their patient-centered primary care approach, CCNC and other PCMH programs hold huge potential for reducing costs (by proactively managing treatment-related AEs in a primary care setting) and for reducing preventable inpatient admissions and ED visits.…”

“…Because Medicaid enrollment can be transient [11], we only included patients who had at least 12 months of Medicaid enrollment during the 15-month postdiagnosis period, so that most of their service claims could be captured. These exclusions followed a protocol that we described previously in another paper [10]. We further excluded patients who were eligible to receive both Medicare and Medicaid benefits, because complete treatment claims for these patients were not available.…”

“…Clinical control variables included cancer stage and comorbidity index, the latter of which was determined using a previously described [10,15] modification of the National Cancer Institute Combined Index algorithm. Cancer stage was derived using the American Joint Committee on Cancer (AJCC) stage grouping, if possible; the Surveillance, Epidemiology, and End Results (SEER) summary staging was used if AJCC stage grouping was not available, or tumor, node, and metastasis (TNM) staging was used if neither AJCC stage grouping nor SEER summary staging was available [16].…”

“…from a medical management team [10]. The CCNC program focuses on patients who are moving across care settings and provides transitional support services such as face-to-face counseling during inpatient admission, medication reconciliation after discharge, self-management training, and other types of patient education.…”

Effects of Distance to Care and Rural or Urban Residence on Receipt of Radiation Therapy Among North Carolina Medicare Enrollees With Breast Cancer

“…Using methods consistent with those described in previously published research [10,31,43], we adjusted for comorbidities identified from Medicare claims using the National Cancer Institute Combined Index, with some modification to allow us to capture comorbid conditions co-occurring during the cancer treatment period [44]. Specifically, comorbidity was measured according to the Charlson Index from 3 months prior to diagnosis through 12 months after diagnosis, and breast-cancer-specific weights were calculated for each condition [44].…”