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Research ArticleArticles

Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients

Effect of Enrollment in a Medical Home Program

Ravi K. Goyal, Stephanie B. Wheeler, Racquel E. Kohler, Kristen H. Lich, Ching-Ching Lin, Katherine Reeder-Hayes, Anne-Marie Meyer and Deborah K. Mayer
North Carolina Medical Journal July 2014, 75 (4) 231-238; DOI: https://doi.org/10.18043/ncm.75.4.231
Ravi K. Goyal
health outcomes scientist, RTI Health Solutions, Research Triangle Park, North Carolina; research associate, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Stephanie B. Wheeler
faculty member, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; assistant professor, Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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  • For correspondence: stephanie_wheeler@unc.edu
Racquel E. Kohler
doctoral student and predoctoral fellow, Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Kristen H. Lich
assistant professor, Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Ching-Ching Lin
doctoral student and predoctoral fellow, Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Katherine Reeder-Hayes
assistant professor, Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill; faculty member, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Anne-Marie Meyer
facility director, Integrated Cancer Information and Surveillance System (ICISS), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Deborah K. Mayer
director of cancer survivorship, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; associate professor, UNC School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Abstract

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.

  • ©2014 by the North Carolina Institute of Medicine and The Duke Endowment.
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North Carolina Medical Journal: 75 (4)
North Carolina Medical Journal
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July-August 2014
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Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients
Ravi K. Goyal, Stephanie B. Wheeler, Racquel E. Kohler, Kristen H. Lich, Ching-Ching Lin, Katherine Reeder-Hayes, Anne-Marie Meyer, Deborah K. Mayer
North Carolina Medical Journal Jul 2014, 75 (4) 231-238; DOI: 10.18043/ncm.75.4.231

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Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients
Ravi K. Goyal, Stephanie B. Wheeler, Racquel E. Kohler, Kristen H. Lich, Ching-Ching Lin, Katherine Reeder-Hayes, Anne-Marie Meyer, Deborah K. Mayer
North Carolina Medical Journal Jul 2014, 75 (4) 231-238; DOI: 10.18043/ncm.75.4.231
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