Racial/ethnic Disparities in Patient-reported Quality of Care Measures among Medicare Breast Cancer Patients: analysis of the SEER-CAHPS Data Set

Authors: Farias AJ, Bang SI, Hamilton A, Du XL

Category: Cancer Health Disparities, Behavioral Science & Health Communication
Conference Year: 2018

Abstract Body:
Purpose: To identify racial/ethnic differences in the proportion of patients that rate excellent experiences with care at the time of cancer diagnosis. Methods: We used the SEER cancer registry and patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)-linked dataset to identify Medicare breast cancer patients who were diagnosed from 1997-2011, 65 years, and completed a CAHPS survey prior to the diagnosis date. CAHPS survey responses were used to generate 4 composite measures of patient experiences with: 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We created a binary measure for each composite score of excellent (90-100) versus not excellent (10-80). In the multivariable logistic regression model examining racial/ethnic differences in the proportion of patients reporting excellent experiences with each composite measure, we included age at survey, marital status, census tract-level poverty and education, SEER region, Medicare insurance type, survey mode (mail versus phone), comorbidities, and survey year. Results: Of the 10,144 patients, 80.7% were non-Hispanic white, 7.6% black, 7.1% Hispanic, and 4.6% Asian. The proportion of patients that reported excellent experiences for each composite measure are: 1) 70.2% for getting medical care when needed, 2) 76.5% for getting prescription care when needed, 3) 58.9% for getting access to medical care quickly, and 4) 65.4% for communicating with their physician. After controlling for potential confounders, Hispanics had lower odds of reporting excellent experiences with getting needed medical care (OR: 0.75, 95% CI:0.63-0.91) and with getting prescription drugs (OR: 0.79, 95% CI:0.65-0.97) compared to non- Hispanic whites. More importantly, this pattern persisted in the stratified analysis by cancer stage I-III for Hispanics versus non-Hispanics whites. Conclusion: Among Medicare breast cancer patients, Hispanics compared to Non-Hispanic whites reported poorer experiences with getting needed care and prescription drugs prior to their diagnosis. Research is needed to determine whether these racial/ethnic differences in patient experiences with care are associated with receipt of appropriate cancer treatment.

Keywords: Quality of care, breast cancer, disparities, SEER- CAHPS