title: Is medical home enrollment associated with receipt of guideline-concordant follow-up care among low-income breast cancer survivors?
abstract: BACKGROUND
  Community Care of North Carolina (CCNC) initiated an innovative medical home program in the 1990 s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes but has not been evaluated in the context of cancer care. We explored whether CCNC enrollment was associated with guideline-concordant follow-up care among breast cancer survivors.
  
  
  METHODS
  Using state cancer registry records matched to Medicaid claims, we identified women 18 to 64 years old who were diagnosed with stage 0, I, II, or unstaged breast cancer from 2003 to 2007 and tracked their monthly CCNC enrollment. Using published American Society for Clinical Oncology guidelines to define our outcomes, we employed multivariate logistic regressions to examine, as a function of CCNC enrollment, receipt of mammogram and at least 2 physical examinations/history-taking visits within observational windows consistent with the guidelines.
  
  
  RESULTS
  Of the 840 women, approximately half were enrolled into the CCNC for some time during the study period. Between 40% and 85% received follow-up mammogram in accordance with guidelines, with significant variation by CCNC status, and 95% of women received at least 2 physical examinations/history-taking visits. In multivariate models, increasing months of CCNC enrollment was significantly positively associated with receipt of follow-up mammogram but not with physical examinations/history-taking visits.
  
  
  CONCLUSIONS
  Results suggest that CCNC enrollment is associated with guideline-concordant follow-up care for Medicaid-insured survivors. Given the growing population of cancer survivors and increased emphasis on primary care medical homes, future studies should explore what factors are associated with medical home participation and whether similar findings are observed with extended follow-up.
authors.affiliation: Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA. stephanie_wheeler@unc.edu
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.forename: Racquel E
authors.initials: RE
authors.lastname: Kohler
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Goyal
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Lich
authors.forename: Ching-Ching
authors.initials: CC
authors.lastname: Lin
authors.forename: Alexis
authors.initials: A
authors.lastname: Moore
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Smith
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Melvin
authors.forename: Katherine
authors.initials: K
authors.lastname: Reeder-Hayes
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011203:Poverty; D012042:Registries; D017741:Survivors; D014481:United States