Fred Hutchinson Cancer Research Center, Seattle, WA
Catherine R. Fedorenko, Laura Elizabeth Panattoni, Julia Rose Walker, Li Li, Karma L. Kreizenbeck, Scott David Ramsey
Background: Uniformity in receipt of high quality cancer care is imperative to reduce health care disparities. In order to help prioritize efforts aimed at reducing disparities in care, we compared several quality metrics for Washington State cancer patients enrolled in Medicaid and commercial insurance plans. Methods: We linked 2014-2016 Washington state cancer registry records for cancer patients under the age of 65 with enrollment and claims records for the two largest commercial insurers in the state and Medicaid. We then generated thirteen nationally recognized quality measures. Outcome measures were adjusted for age, sex, comorbidity score, stage, cancer site, and treatment factors where appropriate. Process measures were not adjusted. Results: 6,868 commercially insured and 2,379 Medicaid patients are represented in the reported quality measures. Conclusions: Care of Washington state cancer patients enrolled in Medicaid is comparable or superior to commercially insured patients, except for significantly higher ED use during chemotherapy. Further research is needed to understand why Medicaid-enrolled cancer patients utilize the ED at more than double the rate of commercially insured patients.
Measure | Tumor Site | Commercial | Medicaid | p-value |
---|---|---|---|---|
Recommended treatment | Breast, lung, colorectal | 92% | 89% | |
Breast | 93% | 90% | ||
Anti-nausea meds during chemotherapy | Breast, lung, colorectal | 98% | 99% | |
Breast | 98% | 99% | ||
Emergency department visits during chemotherapy* | All except leukemia | 21% | 43% | p < 0.001 |
Inpatient stays during chemotherapy* | All except leukemia | 27% | 34% | |
Advanced imaging after treatment | Breast, lung, colon | 14% | 17% | |
Breast | 15% | 25% | p = 0.04 | |
Tumor marking testing after treatment | Breast | 30% | 24% | |
End of Life (EoL): Chemotherapy | Solid | 10% | 9% | |
EoL: 2+ ED visits* | Solid | 16% | 21% | |
EoL: ICU stay* | Solid | 26% | 22% | p = 0.04 |
EoL: Hospice | Solid | 38% | 43% | p = 0.04 |
* Outcome measure
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