title: Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment.
abstract: BACKGROUND
  Racial/ethnic and socioeconomic disparities persist in part because our current understanding of the care provided to minority and disadvantaged populations is limited. The authors evaluated the quality of breast cancer care in 2 large states to understand the disparities experienced by African Americans, Hispanics, Asian/Pacific Islanders (APIs), and Medicaid enrollees and to prioritize remediation strategies.
  
  
  METHODS
  Statewide cancer registry data for 80,436 women in New York and 121,233 women in California who were diagnosed during 2004 to 2009 with stage 0 through III breast cancer were used to assess underuse and overuse of surgery, radiation, chemotherapy, and hormone therapy based on 34 quality measures. Concordance values were compared across racial/ethnic and Medicaid-enrollment groups. Multivariable models were used to quantify disparities across groups for each treatment in each state.
  
  
  RESULTS
  Overall concordance was 76% for underuse measures and 87% for overuse measures. The proportions of patients who received care concordant with all relevant measures were 35% in New York and 33% in California. Compared with whites, African Americans were less likely to receive recommended surgery, radiation, and hormone therapy; Hispanics and APIs were usually more likely to receive recommended chemotherapy. Across states, the same racial/ethnic groups did not always experience the same disparities. Medicaid enrollment was associated with decreased likelihood of receiving all recommended treatments, except chemotherapy, in both states. Overuse was evident for hormone therapy and axillary surgery but was not associated with race/ethnicity or Medicaid enrollment.
  
  
  CONCLUSIONS
  Patient-level measures of quality identify substantial problems with care quality and meaningful disparities. Remediating these problems will require prioritizing low-performing measures and targeting high-risk populations, possibly in different ways for different regions.
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.affiliation: Cancer Registry, New York State Department of Health, Albany, New York.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schymura
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Kun
authors.initials: K
authors.lastname: Chen
authors.affiliation: Cancer Registry, New York State Department of Health, Albany, New York.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe
authors.affiliation: Office of Quality and Patient Safety, New York State Department of Health, Albany, New York.
authors.forename: Foster C
authors.initials: FC
authors.lastname: Gesten
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D002140:California; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009518:New York; D011787:Quality of Health Care / Q000592:standards; D012042:Registries; D014481:United States
keywords: Medicaid; breast cancer; disparities; quality