Associations between shared care and patient experiences among older cancer survivors
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Associations between shared care and patient experiences among older cancer survivors Michael T. Halpern 1
&
Julia Cohen 2 & Lisa M. Lines 2,3 & Michelle A. Mollica 1 & Erin E. Kent 4
Received: 9 January 2020 / Accepted: 30 August 2020 # This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Purpose Cancer survivors have unique medical care needs. “Shared care,” delivered by both oncologists and primary care providers (PCPs), may better address these needs. Little information is available on differences in outcomes among survivors receiving shared care versus oncologist-led or PCP-led care. This study compared experiences of care for survivors receiving shared care, oncologist-led, PCP-led, or other care patterns. Methods We used SEER-CAHPS data, including NCI’s SEER registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses. Medicare Fee-for-Service beneficiaries age ≥ 65 years in SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey ≥ 18 months post-diagnosis were included. CAHPS measures included ratings of overall care, personal doctor, specialist physician, health plan, prescription drug plan, and five composite scores. Survivorship care patterns were identified using proportions of oncologist, PCP, and other physician encounters. Multivariable regressions examined associations between care patterns and CAHPS outcomes. Results Among 10,132 survivors, 15% received shared care, 10% oncologist-led, 33% PCP-led, and 42% other. Compared with shared care, we found no significant differences in experiences of care except for getting needed drugs (lower scores for PCP-led and other care patterns). Sensitivity analyses using different patterns of care definitions similarly showed no associations between survivorship care pattern and experience of care. Conclusions Within the limitations of the study dataset, survivors age 65+ receiving shared care reported similar experiences of care to those receiving oncologist-led, PCP-led, and other patterns of care. Implications for Cancer Survivors Shared care may not provide survivor-perceived benefits compared with other care patterns. Keywords Survivorship . Oncology . Physician practice patterns . Patient satisfaction . Claims analyses . SEER program
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11764-020-00934-3) contains supplementary material, which is available to authorized users. * Michael T. Halpern [email protected] 1
Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD 20850, USA
2
RTI International, Research Triangle Park, Durham, NC 27709, USA
3
University of Massachusetts Medical School, Worcester, MA 01655, USA
4
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
In January 2019, there were approximately 16.9 m
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