title: Timeliness and quality of diagnostic care for medicare recipients with chronic lymphocytic leukemia.
abstract: BACKGROUND
  Little is known about the patterns of care relating to the diagnosis of chronic lymphocytic leukemia (CLL), including the use of modern diagnostic techniques such as flow cytometry.
  
  
  METHODS
  The authors used the SEER-Medicare database to identify subjects diagnosed with CLL from 1992 to 2002 and defined diagnostic delay as present when the number of days between the first claim for a CLL-associated sign or symptom and SEER diagnosis date met or exceeded the median for the sample. The authors then used logistic regression to estimate the likelihood of delay and Cox regression to examine survival.
  
  
  RESULTS
  For the 5086 patients analyzed, the median time between sign or symptom and CLL diagnosis was 63 days (interquartile range [IQR] = 0-251). Predictors of delay included age ≥75 (OR 1.45 [1.27-1.65]), female gender (OR 1.22 [1.07-1.39]), urban residence (OR 1.46 [1.19 to 1.79]), ≥1 comorbidities (OR 2.83 [2.45-3.28]) and care in a teaching hospital (OR 1.20 [1.05-1.38]). Delayed diagnosis was not associated with survival (HR 1.11 [0.99-1.25]), but receipt of flow cytometry within thirty days before or after diagnosis was (HR 0.84 [0.76-0.91]).
  
  
  CONCLUSIONS
  Sociodemographic characteristics affect diagnostic delay for CLL, although delay does not seem to impact mortality. In contrast, receipt of flow cytometry near the time of diagnosis is associated with improved survival.
authors.affiliation: Division of Nursing Business and Health System, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Lysa S
authors.initials: LS
authors.lastname: Magazu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Brown
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D057210:Delayed Diagnosis; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D006278:Medicare; D018426:SEER Program; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States