title: Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C.
abstract: BACKGROUND
  Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection.
  
  
  METHODS
  We used Medicare claims (2006-2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively.
  
  
  RESULTS
  We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt.
  
  
  CONCLUSIONS
  Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.
authors.affiliation: a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.
authors.forename: Viktor V
authors.initials: VV
authors.lastname: Chirikov
authors.affiliation: a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.|b 2 University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Fadia T
authors.initials: FT
authors.lastname: Shaya
authors.affiliation: a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
authors.affiliation: a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: dosReis
authors.affiliation: a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.
authors.forename: Ebere
authors.initials: E
authors.lastname: Onukwugha
authors.affiliation: c 3 Department of Medicine, Howard University College of Medicine, 2041 Georgia Ave. Suite 5C02, Washington, DC 20060, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Howell
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D006233:Persons with Disabilities; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006301:Health Services Needs and Demand / Q000592:standards; D006302:Health Services Research; D054625:Healthcare Disparities / Q000592:standards*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008297:Male; D006278:Medicare / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment / Q000592:standards; D016017:Odds Ratio; D017064:Process Assessment, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007372:Interferons
keywords: Medicare disabled; contextual analysis; quality of care; substance; substance abuse; vulnerable population