Performance on cancer quality measures: Ethnicity, insurance, and census division disparities.

Abstract

34 Background: Since enactment of Healthy People 2000 (ODPHP.gov, nd), a focus has been to reduce disparity by achieving health equity across all people. We examined disparity for five cancer quality measures with high performance rates (PRs) ( > 85%). Methods: Five measures developed by the Commission on Cancer and endorsed by the National Quality Forum were evaluated for potential ethnicity, insurance, and Census Division disparities. Data from the National Cancer Database were used to examine hospital-level PRs on adjuvant chemotherapy for ER neg breast ca (MAC), hormone therapy for ER+ breast ca (HT), resection of at least 12 nodes in a colon resection (12RLN), and adjuvant chemotherapy for stage III colon ca (ACT) measures for patients diagnosed in 2015. Patients receiving radiation after breast conservation surgery (BCSRT) were diagnosed in 2014 to ensure complete treatment follow-up. Results: Significant disparities exist for all measures on ethnicity between non-Hispanic whites and Hispanics. The least variation of ethnicity occurred within 12RLN (non-significant). Variability within insurance was found most frequently with HT and BCSRT measures, not insured/Medicaid versus Medicare, and not insured/Medicaid versus Private respectively. Location disparity exists for all measures, with South Central states’ significantly lower PRs. Further investigation should focus on access, insurability, and delivery of care to better understand and eliminate disparities. Conclusions: Cancer quality measures, which show high performance nationally, show significant performance variability reflective of on-going disparities of care. [Table: see text]