title: Health care utilization from chemotherapy-related adverse events among low-income breast cancer patients: effect of enrollment in a medical home program.
abstract: BACKGROUND
  Chemotherapy-related health care utilization by breast cancer patients can be expensive for payers and patients. This study evaluated the patient-centered medical home program Community Care of North Carolina (CCNC) in terms of its potential to reduce health care utilization associated with chemotherapy-related adverse events (AEs).
  
  
  METHODS
  Early-stage breast cancer cases diagnosed during the 5-year period 2003-2007 were identified in the North Carolina Central Cancer Registry; these cases were then linked to North Carolina Medicaid claims data. We measured health care utilization associated with chemotherapy-related AEs by setting (inpatient, outpatient, or emergency department) during a 15-month postdiagnosis follow-up period. Descriptive and multivariate analyses were performed to examine associations between CCNC enrollment and health care utilization associated with chemotherapy-related AEs.
  
  
  RESULTS
  A large proportion of breast cancer patients had at least 1 health care visit associated with a chemotherapy-related AE (n = 412 [72.3%]). The mean numbers of AE-related visits occurring in inpatient, outpatient, and emergency department settings were 0.30 (standard deviation [SD] = 0.83), 6.92 (SD = 10.94), and 0.46 (SD = 1.26), respectively. CCNC enrollment was associated with significantly fewer inpatient admissions (marginal effect, -0.1421; 95% confidence interval, -0.280 to -0.004).
  
  
  CONCLUSIONS
  In this observational study, we were unable to draw conclusions about the causality of these associations.
  
  
  CONCLUSIONS
  Patients enrolled in CCNC had fewer inpatient health care visits associated with chemotherapy-related AEs. Future research should continue to explore the extent to which patient-centered medical homes can monitor and help manage the effects of cancer treatments.
authors.affiliation: RTI Health Solutions, Research Triangle Park, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Goyal
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. stephanie_wheeler@unc.edu.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Racquel E
authors.initials: RE
authors.lastname: Kohler
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Lich
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ching-Ching
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Hematology and Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Reeder-Hayes
authors.affiliation: Integrated Cancer Information and Surveillance System (ICISS), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; UNC School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D014481:United States
chemical_list: D000970:Antineoplastic Agents