scholarly journals Quality of Care for Breast Cancer for Uninsured Women in California Under the Breast and Cervical Cancer Prevention Treatment Act

2010 ◽  
Vol 28 (21) ◽  
pp. 3479-3484 ◽  
Author(s):  
Jennifer L. Malin ◽  
Allison L. Diamant ◽  
Barbara Leake ◽  
Yihang Liu ◽  
Amardeep Thind ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Quality Of Care ◽  
Cancer Prevention ◽  
Cancer Care ◽  
Quality Measures ◽  
Cervical Cancer Prevention ◽  
Recommended Care ◽  
Breast And Cervical Cancer

Purpose The objective of this study was to evaluate the quality of care provided to uninsured women with breast cancer who received treatment through the Breast and Cervical Cancer Prevention Treatment Program (BCCTP). Methods Participants included women with stage I to III breast cancer (n = 658) from a consecutive sample of women 18 years or older who received coverage through the California BCCTP between February 2003 and September 2005 who consented to a survey and medical record review (61% response rate). Quality of breast cancer care was evaluated using 29 evidence-based quality measures developed for the National Initiative for Cancer Care Quality (NICCQ). NICCQ, a largely insured cohort of women diagnosed with stage I to III breast cancer in 1998, was used to benchmark the results. Results Twenty-three percent of women presented with stage III disease compared with fewer than 10% nationally. Patients received 93% of recommended care (95% CI, 92% to 93%). Adherence to recommended care within domains ranged from 87% for post-treatment surveillance (95% CI, 84% to 90%) to 97% for diagnostic evaluation (95% CI, 96% to 97%). Compared to the NICCQ cohort, adherence to quality measures was as good or better for the BCCPT cohort in all domains except post-treatment surveillance. Conclusion The BCCTP has made important inroads in providing poor, uninsured women with access to high quality care when faced with the diagnosis of breast cancer; however, many present at an advanced stage, which is associated with worse outcomes.

Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?

2006 ◽  
Vol 24 (4) ◽  
pp. 626-634 ◽  
Author(s):  
Jennifer L. Malin ◽  
Eric C. Schneider ◽  
Arnold M. Epstein ◽  
John Adams ◽  
Ezekiel J. Emanuel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
United States ◽  
Cancer Care ◽  
Medical Records ◽  
Significant Variation ◽  
Quality Measures ◽  
The United States ◽  
Recommended Care

Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures. Results Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs. Conclusion Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.

scholarly journals Treatment Patterns Among Medicaid-Eligible Women With Breast Cancer in Georgia: Are Patterns Different Under the Breast and Cervical Cancer Prevention and Treatment Act?

2012 ◽  
Vol 8 (1) ◽  
pp. 46-52 ◽  
Author(s):  
E. Kathleen Adams ◽  
Li-Nien Chien ◽  
Sheryl G.A. Gabram-Mendola
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Cancer Prevention ◽  
Low Income ◽  
Cervical Cancer Prevention ◽  
Treatment Patterns ◽  
Breast And Cervical Cancer ◽  
Prevention And Treatment ◽  
Medicaid Eligibility ◽  
Access Services

The Breast and Cervical Cancer Prevention and Treatment Act program in Georgia creates a quicker pathway for low-income, uninsured women with breast cancer to access services and receive more treatment than women enrolled in traditional Medicaid eligibility groups.

Improving the organisation of breast cancer care increases quality of care while reducing costs

2004 ◽  
Vol 2 (3) ◽  
pp. 113
Author(s):  
G.L Beets ◽  
C.N.A Frotscher ◽  
C.D Dirksen ◽  
M.H Hebly ◽  
M.F von Meyenfeldt
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Breast Cancer Care ◽  
Reducing Costs

Proposed Agenda for the Measurement of Quality-of-Care Outcomes in Oncology Practice

1999 ◽  
Vol 17 (8) ◽  
pp. 2614-2614 ◽  
Author(s):  
Jeanne S. Mandelblatt ◽  
Patricia A. Ganz ◽  
Katherine L. Kahn
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Cancer Care ◽  
The United States ◽  
Leadership Role ◽  
Institute Of Medicine ◽  
Oncology Practice ◽  
The Impact

ABSTRACT: Cancer is an important disease, and health care services have the potential to improve the quality and quantity of life for cancer patients. The delivery of these services also has recently been well codified. Given this framework, cancer care presents a unique opportunity for clinicians to develop and test outcome measures across diverse practice settings. Recently, the Institute of Medicine released a report reviewing the quality of cancer care in the United States and called for further development and monitoring of quality indicators. Thus, as we move into the 21st century, professional and regulatory agencies will be seeking to expand process measures and develop and validate outcomes-oriented measures for cancer and other diseases. For such measures to be clinically relevant and feasible, it is key that the oncology community take an active leadership role in this process. To set the stage for such activities, this article first reviews broad methodologic concerns involved in selecting measures of the quality of care, using breast cancer to exemplify key issues. We then use the case of breast cancer to review the different phases of cancer care and provide examples of phase-specific measures that, after careful operationalization, testing, and validation, could be used as the basis of an agenda for measuring the quality of breast cancer care in oncology practice. The diffusion of process and outcome measures into practice; the practicality, reliability, and validity of these measures; and the impact that these indicators have on practice patterns and the health of populations will be key to evaluating the success of such quality-of-care paradigms. Ultimately, improved quality of care should translate into morbidity and mortality reductions.

Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6547-6547
Author(s):  
H. Mukai ◽  
T. Higashi ◽  
T. Iwase ◽  
T. Sobue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Adherence Score ◽  
Breast Cancer Registry

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.

Breast cancer patients' quality of care: Does racial concordance matter or is it just a matter of trust?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
K. P. Joseph ◽  
R. Franco ◽  
K. Fei ◽  
N. Bickell
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Perceived Quality ◽  
Care Quality ◽  
Breast Cancer Patients ◽  
Office Staff ◽  
Racial Concordance

6537 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients' perceived quality of cancer care matter. Concordance by race in physician-patient relationships has been associated with patient satisfaction and use of health care, however how that is mediated is unclear. Methods: 210 of 300 eligible women stage I or II breast cancer at 1 of 8 participating NYC hospitals responded to our survey (70% response rate): 20% were African-American (AA), 40% were white, and 30% were Hispanic and 9% were other races. Trust is based on a validated scale and calibrated to a 100 point scale (Cronbach α = 0.76). Bivariate analyses and logistic models were used to identify factors associated with patient ratings of quality of care. Results: Only 55% of women rated the quality of their cancer care as excellent. AA women breast cancer patients were less likely to rate their care as excellent (p=0.004). Compared to women who didn't rate their care as excellent, those who rated it excellent had greater trust in their physician (p < 0.0001) and indicated that were treated well by their physicians' office staff (p = 0.01). Of note, AA patients had lower levels of trust (p = 0.004). Women who were of the same race as their physician did not perceive better quality of care as compared to those who were not racially concordant (p = 0.18); nor did they have higher trust in their physician (p = 0.59). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to, how well the staff treated the patient, and racial concordance with physician, found that trust in physician was significantly associated with patient perception of excellent quality care (aRR = 1.38; 95%CI: 1.03–1.65) and being AA was associated with worse perceived quality (aRR = 0.47; 95%CI: 0.21–0.88) (model c = 0.79; p < 0.0001). Conclusions: Racial concordance between physicians and patients does not directly affect patients' perceived quality of care. However, women's trust in their physician and their perceived treatment by office staff are associated with excellent cancer care quality ratings. Efforts should be made to increase effective intercultural communication particularly among AA women in order to improve ratings of cancer care quality. No significant financial relationships to disclose.

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