Claims-Based Measures of Care Coordination and Long-Term Health Among Older Women With Endometrial Cancer.

Abstract

Background: Coordination of care between providers may help ensure that cancer survivors receive the appropriate health care services to improve their long-term health. We examined associations between a claims-based measure of care coordination and several health outcomes among older endometrial cancer survivors.

Methods: Using SEER-Medicare data, we identified women with endometrial cancer at ages 66+ during 2009-2015 (N=13,696). Medicare claims during years 1-3 postdiagnosis were used to calculate care density, a measure of care coordination, as the ratio of the number of patients shared among a woman's outpatient providers to the number of provider pairs seen by that patient. We estimated associations between care density tertile and hospitalizations, emergency room (ER) visits, and all-cause mortality from 3 years postdiagnosis on, and adherence to guideline-recommended follow-up during years 3-5 postdiagnosis.

Results: No clear trends were observed for risk of all-cause mortality, hospitalizations or ER visits according to care density category. However, for hospitalizations (HR=0.93; 95% CI: 0.87-0.99) and ER visits (HR=0.93; 95% CI: 0.88-0.98), there was a slightly lower risk in the highest care density tertile compared with the lowest. Women in the middle (OR=1.67; 95% CI: 1.40-2.00) and highest care density tertiles (OR=1.63; 95% CI: 1.36-1.96) were more likely to be adherent to follow-up recommendations than those in the lowest tertile.

Conclusions: Greater care coordination during the early survivorship period may be associated with a slightly lower risk of hospitalization and ER visits and better adherence to surveillance recommendations after endometrial cancer.