The Association of Medicare Health Care Delivery Systems With Stage at Diagnosis and Survival for Patients With Melanoma

Disparities in the Presentation and Management of Cutaneous Melanoma That Required Admission

“…Most studies agree that melanoma risk is higher in population of high socioeconomic status, while a worse prognosis is more relevant in populations of low socioeconomic status [5, 11, 16, 29, 33]. There is some evidence that the differences in patient outcomes are associated with the type of health care delivery system in which they are enrolled [14, 15, 35]. In 2 previous studies, a decreased survival rate in Medicaid enrollees was observed in patients from ­California and Ohio [4, 28].…”

Ovarian cancer: predictors of early-stage diagnosis

“…In addition to access to care, insurance status can affect whether or not an individual receives regular care from a primary care physician. Previous studies have demonstrated that continuity of care offered by primary care physicians can lead to earlier-stage cancer diagnosis[36,37]. The impact of SES on cancer stage at diagnosis has also been amply demonstrated, particularly for cancers that are screenable, or that present with clear clinical signs.…”

Effect of Health Care Delivery Models on Melanoma Thickness and Stage in a University-Based Referral Center

“…While our pilot study is small in comparison with the analysis of Kirsner et al, 9 it has the advantages of including patients of all ages with melanoma; expanded and more accurate determination of health care model per subject; inclusion of tumor characteristics including ulceration, visible pigmentation, and histogenetic subtype; and more precise staging of cutaneous melanoma, adhering to the 2002 AJCC melanoma staging system, as opposed to the broader categories of in situ, local, regional, and distant disease used for staging in the Medicare analysis. 9 Furthermore, it addresses the ques-tion of how GK-associated managed care affects melanoma thickness, an issue not completely captured in the large-scale Medicare HMO and FFS comparative analyses, since traditional HMO-directed care may include health plans with direct access to dermatology, as in the Kaiser Permanente system. Patient delay in seeking medical care has been proposed as the principal factor impeding early diagnosis of 12,15,17 although few studies 15,16 have demonstrated a positive correlation between duration of patient delay and prognostic indicators such as tumor thickness or stage at diagnosis.…”

“…[12][13][14][15][16][17][18] While various studies have suggested that diagnostic accuracy of melanoma improves with specialty training in dermatology, [19][20][21][22][23] few have specifically addressed the role of the health care delivery model on melanoma outcome or have been performed outside of the older Medicare population. 5,9 We conducted a retrospective study to assess the role of direct dermatology access compared with primary care/gatekeeper-regulated specialty access on melanoma outcome as measured by tumor thickness and cancer stage at diagnosis.…”