Baseline utilization of breast radiotherapy before institution of the Medicare practice quality reporting initiative.
OBJECTIVE
In 2007, Medicare implemented the Physician Quality Reporting Initiative (PQRI), which provides financial incentives to physicians who report their performance on certain quality measures. PQRI measure #74 recommends radiotherapy for patients treated with conservative surgery (CS) for invasive breast cancer. As a first step in evaluating the potential impact of this measure, we assessed baseline use of radiotherapy among women diagnosed with invasive breast cancer before implementation of PQRI.


METHODS
Using the SEER-Medicare data set, we identified women aged 66-70 diagnosed with invasive breast cancer and treated with CS between 2000 and 2002. Treatment with radiotherapy was determined using SEER and claims data. Multivariate logistic regression tested whether receipt of radiotherapy varied significantly across clinical, pathologic, and treatment covariates.


RESULTS
Of 3,674 patients, 94% (3,445) received radiotherapy. In adjusted analysis, the presence of comorbid illness (odds ratio [OR] 1.69; 95% confidence interval [CI], 1.19-2.42) and unmarried marital status were associated with omission of radiotherapy (OR 1.65; 95% CI, 1.22-2.20). In contrast, receipt of chemotherapy was protective against omission of radiotherapy (OR 0.25; 95% CI, 0.16-0.38). Race and geographic region did not correlate with radiotherapy utilization.


CONCLUSIONS
Utilization of radiotherapy following CS was high for patients treated before institution of PQRI, suggesting that at most 6% of patients could benefit from measure #74. Further research is needed to determine whether institution of PQRI will affect radiotherapy utilization.
Smith
Benjamin D
BD
Radiation Oncology Flight, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA. bensmith@alumni.rice.edu
Smith
Grace L
GL
Roberts
Kenneth B
KB
Buchholz
Thomas A
TA
D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007357:Insurance, Physician Services / Q000191:economics / Q000331:legislation & jurisprudence*; D016015:Logistic Models; D015412:Mastectomy, Segmental / Q000331:legislation & jurisprudence; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D011878:Radiotherapy / Q000191:economics / Q000706:statistics & numerical data; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States