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Associations between illness burden and care experiences among Medicare beneficiaries before or after a cancer diagnosis

  • Lisa M. Lines
    Correspondence
    Corresponding author at: RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America.
    Affiliations
    RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America

    University of Massachusetts Chan Medical School, 55 Lake Ave., North Worcester, MA 01655, United States of America
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  • Julia Cohen
    Affiliations
    RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
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  • Justin Kirschner
    Affiliations
    RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
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  • Daniel H. Barch
    Affiliations
    RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America

    Psychology Department, Tufts University, Medford, MA, United States of America
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  • Michael T. Halpern
    Affiliations
    National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
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  • Erin E. Kent
    Affiliations
    Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America

    University of North Carolina Lineberger Comprehensive Cancer Center, United States of America
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  • Michelle A. Mollica
    Affiliations
    National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
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  • Ashley Wilder Smith
    Affiliations
    National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
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Published:March 08, 2022DOI:https://doi.org/10.1016/j.jgo.2022.02.017

      Abstract

      Introduction

      To understand associations between a new measure of illness burden and care experiences in a large, national sample of Medicare beneficiaries surveyed before or after a cancer diagnosis.

      Materials and Methods

      The SEER-CAHPS Illness Burden Index (SCIBI) was previously developed using Surveillance, Epidemiology, and End Results (SEER)–Consumer Assessment of Healthcare Providers and Systems (CAHPS) linked data. The SCIBI provides a standardized morbidity score based on self- and other-reported information from 8 domains and proxies relative risk of 12-month, all-cause mortality among people surveyed before or after a cancer diagnosis. We analyzed a population of Medicare beneficiaries (n = 116,735; 49% fee-for-service and 51% Medicare Advantage [MA]; 73% post-cancer diagnosis) surveyed 2007–2013 to understand how their SCIBI scores were associated with 12 different care experience measures. Frequentist and Bayesian multivariable regression models adjusted for standard case-mix adjustors, enrollment type, timing of cancer diagnoses relative to survey, and survey year.

      Results and Discussion

      SCIBl scores were associated (P < .001) in frequentist models with better ratings of Health Plan (coefficient ± standard error: 0.33 ± 0.08) and better Getting Care Quickly scores (0.51 ± 0.09). In Bayesian models, individuals with higher illness burden had similar results on the same two measures and also reported reliably worse Overall Care experiences (coefficient ± posterior SD: −0.17 ± 0.06). Illness burden may influence how people experience care or report those experiences. Individuals with greater illness burdens may need intensive care coordination and multilevel interventions before and after a cancer diagnosis.

      Keywords

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