title: Comorbid condition care quality in cancer survivors: role of primary care and specialty providers and care coordination.
abstract: OBJECTIVE
  The purpose of this study is to investigate provider specialty, care coordination, and cancer survivors' comorbid condition care.
  
  
  METHODS
  This retrospective cross-sectional Surveillance, Epidemiology, and End Results (SEER)-Medicare study included cancer survivors diagnosed in 2004, 2-3 years post-cancer diagnosis, in fee-for-service Medicare. We examined (1) provider specialties (primary care providers (PCPs), oncology specialists, other specialists) visited post-hospitalization, (2) role of provider specialties in chronic and acute condition management, and (3) an ambulatory care coordination measure. Outcome measures covered (1) visits post-hospitalization for nine conditions, (2) chronic disease management (lipid profile, diabetic eye exam, diabetic monitoring), and (3) acute condition management (electrocardiogram (EKG) for congestive heart failure (CHF), imaging for CHF, EKG for transient ischemic attack, cholecystectomy, hip fracture repair).
  
  
  RESULTS
  Among 8661 cancer survivors, patients were more likely to visit PCPs than oncologists or other specialists following hospitalizations for 8/9 conditions. Patients visiting a PCP (vs. not) were more likely to receive recommended care for 3/3 chronic and 1/5 acute condition indicators. Patients visiting a nother specialist (vs. not) were more likely to receive recommended care for 3/3 chronic and 2/5 acute condition indicators. Patients visiting an oncology specialist (vs. not) were more likely to receive recommended care on 2/3 chronic indicators and less likely to receive recommended care on 1/5 acute indicators. Patients at greatest risk for poor coordination were more likely to receive appropriate care on 4/6 indicators.
  
  
  CONCLUSIONS
  PCPs are central to cancer survivors' non-cancer comorbid condition care quality. Implications for Cancer Survivors PCP involvement in cancer survivors' care should be promoted.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, 624 N. Broadway, Room 649, Baltimore, MD, 21205, USA. csnyder@jhu.edu.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. csnyder@jhu.edu.|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA. csnyder@jhu.edu.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.affiliation: Ariadne Labs, Boston, MA, USA.
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Lemke
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carducci
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Wolff
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards; D012189:Retrospective Studies; D018426:SEER Program; D013038:Specialization; D017741:Survivors / Q000706:statistics & numerical data
keywords: Cancer survivorship; Comorbidity; Quality of care