PMID- 25046085
OWN - NLM
STAT- MEDLINE
DCOM- 20141023
LR  - 20191112
IS  - 0029-2559 (Print)
IS  - 0029-2559 (Linking)
VI  - 75
IP  - 4
DP  - 2014 Jul-Aug
TI  - Health care utilization from chemotherapy-related adverse events among low-income 
      breast cancer patients: effect of enrollment in a medical home program.
PG  - 231-8
AB  - BACKGROUND: Chemotherapy-related health care utilization by breast cancer 
      patients can be expensive for payers and patients. This study evaluated the 
      patient-centered medical home program Community Care of North Carolina (CCNC) in 
      terms of its potential to reduce health care utilization associated with 
      chemotherapy-related adverse events (AEs). METHODS: Early-stage breast cancer 
      cases diagnosed during the 5-year period 2003-2007 were identified in the North 
      Carolina Central Cancer Registry; these cases were then linked to North Carolina 
      Medicaid claims data. We measured health care utilization associated with 
      chemotherapy-related AEs by setting (inpatient, outpatient, or emergency 
      department) during a 15-month postdiagnosis follow-up period. Descriptive and 
      multivariate analyses were performed to examine associations between CCNC 
      enrollment and health care utilization associated with chemotherapy-related AEs. 
      RESULTS: A large proportion of breast cancer patients had at least 1 health care 
      visit associated with a chemotherapy-related AE (n = 412 [72.3%]). The mean 
      numbers of AE-related visits occurring in inpatient, outpatient, and emergency 
      department settings were 0.30 (standard deviation [SD] = 0.83), 6.92 (SD = 
      10.94), and 0.46 (SD = 1.26), respectively. CCNC enrollment was associated with 
      significantly fewer inpatient admissions (marginal effect, -0.1421; 95% 
      confidence interval, -0.280 to -0.004). LIMITATIONS: In this observational study, 
      we were unable to draw conclusions about the causality of these associations. 
      CONCLUSIONS: Patients enrolled in CCNC had fewer inpatient health care visits 
      associated with chemotherapy-related AEs. Future research should continue to 
      explore the extent to which patient-centered medical homes can monitor and help 
      manage the effects of cancer treatments.
FAU - Goyal, Ravi K
AU  - Goyal RK
AD  - RTI Health Solutions, Research Triangle Park, North Carolina; Lineberger 
      Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel 
      Hill, North Carolina, USA.
FAU - Wheeler, Stephanie B
AU  - Wheeler SB
AD  - Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel 
      Hill; Department of Health Policy and Management, UNC Gillings School of Global 
      Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North 
      Carolina, USA. stephanie_wheeler@unc.edu.
FAU - Kohler, Racquel E
AU  - Kohler RE
AD  - Department of Health Policy and Management, UNC Gillings School of Global Public 
      Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 
      USA.
FAU - Lich, Kristen H
AU  - Lich KH
AD  - Department of Health Policy and Management, UNC Gillings School of Global Public 
      Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 
      USA.
FAU - Lin, Ching-Ching
AU  - Lin CC
AD  - Department of Health Policy and Management, UNC Gillings School of Global Public 
      Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 
      USA.
FAU - Reeder-Hayes, Katherine
AU  - Reeder-Hayes K
AD  - Division of Hematology and Oncology, UNC School of Medicine, University of North 
      Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of 
      North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
FAU - Meyer, Anne-Marie
AU  - Meyer AM
AD  - Integrated Cancer Information and Surveillance System (ICISS), Lineberger 
      Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel 
      Hill, North Carolina, USA.
FAU - Mayer, Deborah K
AU  - Mayer DK
AD  - Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel 
      Hill; UNC School of Nursing, University of North Carolina at Chapel Hill, Chapel 
      Hill, North Carolina, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - N C Med J
JT  - North Carolina medical journal
JID - 2984805R
RN  - 0 (Antineoplastic Agents)
SB  - IM
MH  - Adult
MH  - Ambulatory Care/economics/statistics & numerical data
MH  - Antineoplastic Agents/*adverse effects
MH  - Breast Neoplasms/*drug therapy
MH  - Emergency Service, Hospital/economics/statistics & numerical data
MH  - Female
MH  - Health Care Costs
MH  - Health Services/economics/*statistics & numerical data
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Medicaid/statistics & numerical data
MH  - Middle Aged
MH  - North Carolina
MH  - Patient-Centered Care/*statistics & numerical data
MH  - Poverty/*statistics & numerical data
MH  - *Registries
MH  - Retrospective Studies
MH  - United States
EDAT- 2014/07/22 06:00
MHDA- 2014/10/24 06:00
CRDT- 2014/07/22 06:00
PHST- 2014/07/22 06:00 [entrez]
PHST- 2014/07/22 06:00 [pubmed]
PHST- 2014/10/24 06:00 [medline]
AID - 75401 [pii]
AID - 10.18043/ncm.75.4.231 [doi]
PST - ppublish
SO  - N C Med J. 2014 Jul-Aug;75(4):231-8. doi: 10.18043/ncm.75.4.231.