title: Receipt of appropriate surgical care for Medicare beneficiaries with cancer.
abstract: OBJECTIVE
  To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data.
  
  
  METHODS
  Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007.
  
  
  METHODS
  Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital.
  
  
  RESULTS
  Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvant therapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest.
  
  
  CONCLUSIONS
  We found a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. ccgreenberg@partners.org
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Bridget
authors.initials: B
authors.lastname: Neville
authors.forename: Haejin
authors.initials: H
authors.lastname: In
authors.forename: Nathanael
authors.initials: N
authors.lastname: Hevelone
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Porter
authors.forename: Christine
authors.initials: C
authors.lastname: Weeks
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States