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Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women.

Publication ,  Journal Article
Anderson, RT; Kimmick, GG; Camacho, F; Whitmire, JT; Dickinson, C; Levine, EA; Torti, FM; Balkrishnan, R
Published in: Am J Manag Care
October 2008

OBJECTIVE: To describe patient and healthcare system correlates of receipt of recommended care in North Carolina (NC) as indicated by receipt of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS). STUDY DESIGN: Retrospective cohort study. METHODS: Subjects were 344 women diagnosed as having primary breast cancer in 1998 and 1999, who were classified as being alive at least 12 months after treatment with BCS. Medicaid claims were used to supplement central cancer registry (CCR) data about adjuvant RT, and hospital medical record verification was performed when no RT was documented. Health system characteristics (size and volume) were obtained from existing databases. RESULTS: Of 344 NC women enrolled in Medicaid and treated with BCS, one third did not receive RT. The following patient and health system characteristics were associated with lack of receipt of adjuvant RT after BCS: older age (>or=65 years), residing in a low-population density county, receiving BCS at a smaller hospital, and living in a county classified as a whole-county specialist scarcity area. CONCLUSIONS: Some low-income women do not access RT following BCS, placing them at risk for worse outcomes than those associated with standard mastectomy. We identify geographic isolation and scarcity of healthcare specialists as possible leverage points for interventions.

Duke Scholars

Published In

Am J Manag Care

EISSN

1936-2692

Publication Date

October 2008

Volume

14

Issue

10

Start / End Page

644 / 652

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Retrospective Studies
  • Registries
  • Poverty
  • North Carolina
  • Middle Aged
  • Medical Records
  • Medicaid
  • Mastectomy
 

Citation

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Anderson, R. T., Kimmick, G. G., Camacho, F., Whitmire, J. T., Dickinson, C., Levine, E. A., … Balkrishnan, R. (2008). Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women. Am J Manag Care, 14(10), 644–652.
Anderson, Roger T., Gretchen G. Kimmick, Fabian Camacho, J Timothy Whitmire, Carol Dickinson, Edward A. Levine, Frank M. Torti, and Rajesh Balkrishnan. “Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women.Am J Manag Care 14, no. 10 (October 2008): 644–52.
Anderson RT, Kimmick GG, Camacho F, Whitmire JT, Dickinson C, Levine EA, et al. Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women. Am J Manag Care. 2008 Oct;14(10):644–52.
Anderson, Roger T., et al. “Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women.Am J Manag Care, vol. 14, no. 10, Oct. 2008, pp. 644–52.
Anderson RT, Kimmick GG, Camacho F, Whitmire JT, Dickinson C, Levine EA, Torti FM, Balkrishnan R. Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women. Am J Manag Care. 2008 Oct;14(10):644–652.

Published In

Am J Manag Care

EISSN

1936-2692

Publication Date

October 2008

Volume

14

Issue

10

Start / End Page

644 / 652

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Retrospective Studies
  • Registries
  • Poverty
  • North Carolina
  • Middle Aged
  • Medical Records
  • Medicaid
  • Mastectomy