前列腺癌成像率似乎因医疗保健环境而异。随着最近退伍军人访问的扩展,Choice,和责任法案,政府已为退伍军人提供资金,以便在退伍军人健康管理局(VA)之外寻求护理。重要的是要了解VA与传统的按服务收费设置(例如Medicare)的成像率差异以及随后的护理模式差异。
评估前列腺癌成像率与VA和按服务收费的医疗保健环境之间的关联。
这项队列研究包括从2004年1月1日至2008年3月31日接受前列腺癌诊断的男性数据,这些数据是从VA中央癌症登记处收集的。链接到管理索赔和医疗保险使用记录,和监视,流行病学,和最终结果程序数据库。构建了三个不同的全国代表性队列(仅使用VA,仅使用Medicare,以及退伍军人管理局和医疗保险的双重用途)。诊断时年龄超过85岁的男性和没有高风险特征但缺少任何肿瘤风险特征的男性(前列腺特异性抗原,格里森等级,或临床分期)被排除。数据分析于2016年3月至2018年2月完成。
患者利用不同的医疗保健提供系统。
按医疗机构分析前列腺癌成像率(仅限Medicare,VA和医疗保险,仅VA)在低危前列腺癌患者和高危前列腺癌患者中。
98867名前列腺癌男性(77.4%为白人;平均[SD]年龄,70.26[7.48]年)在研究队列中,57.3%的人只属于医疗保险组,VA和医疗保险组的14.5%,仅VA组为28.1%。在患有低风险前列腺癌的男性中,仅Medicare组的指南不一致成像率最高(52.5%),其次是VA和Medicare组(50.9%)和仅VA组(45.9%)(P<.001)。3组患者高危前列腺癌患者的成像率无显著差异。多变量分析表明,VA和医疗保险组的个体(风险比[RR],0.87;95%CI,0.76-0.98)和仅VA组(RR,0.79;95%CI,0.67-0.92)与仅Medicare组相比,接受指南不一致成像的可能性较小。
这项研究的结果表明,使用Medicare而不是VA进行医疗保健的前列腺癌患者可以更多地利用医疗保健服务,而不会提高护理质量。
Prostate cancer imaging rates appear to vary by health care setting. With the recent extension of the Veterans Access, Choice, and Accountability Act, the government has provided funds for veterans to seek care outside the Veterans Health Administration (VA). It is important to understand the difference in imaging rates and subsequent differences in patterns of care in the VA vs a traditional fee-for-service setting such as Medicare.
To assess the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting.
This cohort study included data for men who received a diagnosis of prostate cancer from January 1, 2004, through March 31, 2008, that were collected from the VA Central Cancer Registry, linked to administrate claims and Medicare utilization records, and the Surveillance, Epidemiology, and End Results Program database. Three distinct nationally representative cohorts were constructed (use of VA only, use of Medicare only, and dual use of VA and Medicare). Men older than 85 years at diagnosis and men without high-risk features but missing any tumor risk characteristic (prostate-specific antigen, Gleason grade, or clinical stage) were excluded. Analysis of the data was completed from March 2016 to February 2018.
Patient utilization of different health care delivery systems.
Rates of prostate cancer imaging were analyzed by health care setting (Medicare only, VA and Medicare, and VA only) among patients with low-risk prostate cancer and patients with high-risk prostate cancer.
Of 98 867 men with prostate cancer (77.4% white; mean [SD] age, 70.26 [7.48] years) in the study cohort, 57.3% were in the Medicare-only group, 14.5% in the VA and Medicare group, and 28.1% in the VA-only group. Among men with low-risk prostate cancer, the Medicare-only group had the highest rate of
guideline-discordant imaging (52.5%), followed by the VA and Medicare group (50.9%) and the VA-only group (45.9%) (P < .001). Imaging rates for men with high-risk prostate cancer were not significantly different among the 3 groups. Multivariable analysis showed that individuals in the VA and Medicare group (risk ratio [RR], 0.87; 95% CI, 0.76-0.98) and VA-only group (RR, 0.79; 95% CI, 0.67-0.92) were less likely to receive
guideline-discordant imaging than those in the Medicare-only group.
The results of this study suggest that patients with prostate cancer who use Medicare rather than the VA for health care could experience more utilization of health care services without an improvement in the quality of care.