Using a Mystery-Caller Approach to Examine Access to Prostate Cancer Care in Philadelphia

Abstract

PurposePrior work suggests that access to health care may influence the diagnosis and treatment of prostate cancer. Mystery-caller methods have been used previously to measure access to care for health services such as primary care, where patients’ self-initiate requests for care. We used a mystery-caller survey for specialized prostate cancer care to assess dimensions of access to prostate cancer care.Materials and MethodsWe created an inventory of urology and radiation oncology practices in southeastern Pennsylvania. Using a ‘mystery caller’ approach, a research assistant posing as a medical office scheduler in a primary care office, attempted to make a new patient appointment on behalf of a referred patient. Linear regression was used to determine the association between time to next available appointment with practice and census tract characteristics.ResultsWe successfully obtained information on new patient appointments from 198 practices out of the 223 in the region (88.8%). Radiation oncology practices were more likely to accept Medicaid compared to urology practices (91.3% vs 36.4%) and had shorter mean wait times for new patient appointments (9.0 vs 12.8 days). We did not observe significant differences in wait times according to census tract characteristics including neighborhood socioeconomic status and the proportion of male African American residents.ConclusionsMystery-caller methods that reflect real-world referral processes from primary care offices can be used to measure access to specialized cancer care. We observed significant differences in wait times and insurance acceptance between radiation oncology and urology practices.

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

“…Table S1 in Supplemental Material summarizes the study characteristics of the 34 articles included in this review. 16-49 In total, the 34 studies represented 21,601 calls to provider offices requesting an appointment for Medicaid and private insurance scenarios, of which 63% resulted in successful scheduling. Of 11,387 calls with private insurance, 80% of calls successfully led to appointments, while 45% of 10 214 calls with Medicaid resulted in none.…”

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

“…Patients were asked the name and address of the cancer specialists and matched to an inventory of practices in the greater Philadelphia region and surrounding counties. The inventory was constructed using data from the National Provider Identifier (NPI) database and a frequently updated proprietary database of physicians organized by specialty and location from SK&A (17). All practices were called to confirm that they diagnose and/or treat patients with prostate cancer and to verify their addresses.…”

A multidimensional view of racial differences in access to prostate cancer care

“…We obtained information regarding all urology and radiation oncology clinics in the Philadelphia area and all adjacent counties (25 total counties) using data from the National Provider Identifier database and SK&A's proprietary commercial database located in Irvine, CA. For the audit survey, research assistants posed as schedulers from a primary care office and requested the next available appointment for a patient with private insurance with an elevated prostate‐specific antigen level . We linked patients to their primary urologist as identified in the survey; 96% of survey respondents were linked successfully.…”

“…For the audit survey, research assistants posed as schedulers from a primary care office and requested the next available appointment for a patient with private insurance with an elevated prostate-specific antigen level. 16 We linked patients to their primary urologist as identified in the survey; 96% of survey respondents were linked successfully.…”