Organizational characteristics and cancer care for nursing home residents.
OBJECTIVE
We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease. DATA SOURCES/STUDY DESIGN/DATA COLLECTION: Using data from the Michigan Tumor Registry (1997-2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis.


RESULTS
Approximately 25 percent of the residents were diagnosed at or near death. Only 61 percent of residents diagnosed with late or unstaged cancer received pain medication during the diagnosis month or the following month. Residents in nursing homes with lower staffing and in counties with fewer hospital beds were more likely to be diagnosed at death. After the Balanced Budget Act (BBA), residents were more likely to be diagnosed at death.


CONCLUSIONS
Nursing home characteristics and community resources are significantly related to the cancer care residents receive. The BBA was associated with an increased likelihood of later diagnosis of cancer.
Department of Health Administration, Virginia Commonwealth University, 1008 Clay Street, Richmond, VA 23298-0203, USA.
Jan P
JP
Clement
Cathy J
CJ
Bradley
Chunchieh
C
Lin
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002017:Budgets; D004608:Eligibility Determination; D005260:Female; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008824:Michigan; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D009735:Nursing Homes / Q000458:organization & administration*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D012042:Registries; D014481:United States