Research using the MEPS Experiences with Cancer Survivorship Supplement can inform efforts by health care policy makers, healthcare systems, providers, and employers to improve the cancer survivorship experience in the USA.
BackgroundIn the United States, the Accreditation Council of graduate medical education (ACGME) requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM) residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents.MethodsWe would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation".ResultsSince the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine.ConclusionInternal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.
Introduction:
There is increasing concern regarding the financial burden of cancer
on patients and their families. This study presents nationally
representative estimates of annual out-of-pocket (OOP) burden among
non-elderly cancer survivors and assesses the association between high OOP
burden and access to care and preventive service utilization.
Methods:
Using the 2008–2012 Medical Expenditure Panel Survey, 4,271
cancer survivors and 96,780 individuals without a history of cancer were
identified, all aged 18–64 years. High annual OOP burden was defined
as spending > 20% of annual family income on OOP healthcare costs.
Associations between high OOP burden and access to care were evaluated with
multivariable logistic regression. Analyses were conducted in 2015.
Results:
Compared with individuals without a cancer history, cancer survivors
were more likely to report a high OOP burden (4.3% vs 3.4%,
p=0.009) in adjusted analyses. High OOP burden was more
common among cancer survivors who were poor (18.4%), with either public
insurance (7.9%) or uninsured (5.7%), and not working (10.2%). Among cancer
survivors, high OOP burden was associated with being unable to obtain
necessary medical care (19.2% vs 12.5%, p=0.002), delaying
necessary medical care (21.6% vs 13.8%, p=0.002), and lower
breast cancer screening rates among age-appropriate women (63.2% vs 75.9%,
p=0.02).
Conclusions:
High OOP burden is more common among adults with a cancer history
than those without a cancer history. High OOP burden was associated with
being unable to obtain necessary medical care, delaying necessary medical
care, and lower breast cancer screening rates among women.
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