TY - JOUR
T1 - Receipt of appropriate surgical care for medicare beneficiaries with cancer
AU - Greenberg, Caprice C.
AU - Lipsitz, Stuart R.
AU - Neville, Bridget
AU - In, Haejin
AU - Hevelone, Nathanael
AU - Porter, Stacy A.
AU - Weeks, Christine
AU - Jha, Ashish K.
AU - Gawande, Atul A.
AU - Schrag, Deborah
AU - Weeks, Jane C.
PY - 2011/10
Y1 - 2011/10
N2 - Objective: To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer. Design: Retrospective cohort study. Setting: National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data. Patients: Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007. Main Outcome Measures: Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital. Results: Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvanttherapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest. Conclusions:Wefound a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.
AB - Objective: To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer. Design: Retrospective cohort study. Setting: National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data. Patients: Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007. Main Outcome Measures: Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital. Results: Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvanttherapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest. Conclusions:Wefound a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.
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U2 - 10.1001/archsurg.2011.141
DO - 10.1001/archsurg.2011.141
M3 - Article
C2 - 21690439
AN - SCOPUS:80054766769
SN - 0004-0010
VL - 146
SP - 1128
EP - 1134
JO - Archives of Surgery
JF - Archives of Surgery
IS - 10
ER -