Meaningful Use: Does Physician Participation Move the Needle on Quality Metrics?

INTRODUCTION: To determine the association between pattern of participation in the Meaningful Use (MU) initiative and self-reported clinical quality metrics. METHODS: We used state-level Medicaid electronic health record (EHR) incentive program data to categorize physicians based on receipt of MU payments (single year vs. multiple years) and self-reported quality metrics from 2011 to 2016. RESULTS: Among 4,198 participating physicians, only 36% received more than one EHR incentive payment. Physicians participating for a single year had better cancer-screening metrics. By comparison, physicians who participated for multiple years reported better medication-related metrics and chronic disease management metrics. CONCLUSIONS: Nature of participation may have varying degrees of influence on types of clinical quality metrics. Sustained participation may support management of chronic conditions. Administrative claims data will help to elucidate our findings.

Work task disability in employed breast and prostate cancer patients.

INTRODUCTION: Nearly 60% of cancer survivors are of working age, making inquiries into work-related disabilities particularly relevant. This paper describes work-related physical and cognitive disability estimates 12 and 18 months after diagnosis and treatment in a sample of employed breast and prostate cancer patients. METHODS: We recruited employed, newly diagnosed patients (n=447 breast, n=267 prostate) from the Metropolitan Detroit Cancer Surveillance System for telephone interviews 12 and 18 months after diagnosis. We defined disability by work task activity limitation. Disability estimates and employment were compared using Pearson chi-square tests. Duration of hours worked was compared by disability status using t-tests. RESULTS: Approximately 60% of women reported physical disability at 12 months which decreased to 36% at 18 months. Cognitive disability was reported by 34% and 22% of women at 12 and 18 months, respectively. Fewer men reported physical disability, only 29% at 12 months, decreasing to 17% at 18 months. Cognitive disability was reported by 12% and 7% of men at 12 and 18 months, respectively. More individuals with disability left the workforce at each timeframe than those without disability. CONCLUSIONS: A significant proportion of breast and prostate cancer patients experienced work-related disabilities 1 year or more following treatment. Physical disability was more problematic than cognitive disability.

Breast and prostate cancer patient's reliability of treatment reporting.

PURPOSE: To compare patient reported cancer treatments with data obtained by trained abstractors in the Metropolitan Detroit Cancer Surveillance System (MDCSS) to assess the reliability of patient interviews as a source for cancer treatments. METHODS: Patients (n=492 breast patients and n=291 prostate patients) were identified from the MDCSS and interviewed approximately 6 months after initial diagnosis for receipt of cancer treatment. Kappa statistics compared agreement between patient's report of their treatments and the MDCSS. RESULTS: Breast cancer patients had moderate levels of agreement regarding receipt of chemotherapy and radiation and excellent agreement for surgery. In contrast, prostate cancer patients and registry reports achieved excellent concordance for radiation therapy, very good agreement for surgery, and moderate levels of agreement for hormone therapy. Sensitivity of chemotherapy, surgery, and radiation reporting exceeded 90% for both patient cohorts. Overall, patients reported more treatment than was recorded i n M DCSS. CONCLUSION: Patients can be reliabledata sources for medical information pertaining to cancer therapies, although recall may vary by treatment type and time since treatment. Protocols involving patient interviews may wish to consider these encounters as timely, reliable data source options.

Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis.

BACKGROUND: A better understanding of how cancer treatments affect patient's employment may help patients and physicians make more informed choices between treatment alternatives. This study examined the number of days employed patients undergoing treatment for either breast or prostate cancer were absent from their jobs. METHOD: Using the Detroit Surveillance, Epidemiology, End-Results registry, all potentially eligible women diagnosed with breast cancer and men diagnosed with prostate cancer were selected. Subjects who were employed full-time were included in this analysis. RESULTS: Women treated for breast cancer missed an average of 44.5 days from work; the median days missed was 22. The median days missed by women treated with surgery and chemotherapy was 40. Men diagnosed with prostate cancer missed an average of 27 days (median days = 20) from work. The median days missed for men treated surgically without hormone or radiation therapy was 25. In multivariable analyses, taking a leave of absence and greater elapsed time from diagnosis to interview were associated with the greatest number of days absent from work for all patients. Men treated with hormone and/or radiation therapy or who were not treated missed fewer days from work relative to men undergoing surgery. CONCLUSION: Research and interventions are needed to minimize work loss for cancer patients. Vocational rehabilitation programs may minimize the impact of treatment on work. Information on how treatments may infringe the ability for patients to earn a living may influence treatment decisions.

Combining registry, primary, and secondary data sources to identify the impact of cancer on labor market outcomes.

Some cancers are rapidly becoming chronic conditions that are more and more often diagnosed in working-age individuals. The authors developed a research agenda to study the labor market outcomes attributable to detection and treatment for cancer, and research design and data collection strategies to improve upon other research on these questions. In this article, they describe their approach to combining secondary data sources, primary data collection, and cancer registry data to evaluate the impact cancer has on labor market outcomes such as employment, hours worked, wages, and health insurance. They then critically assess how well their study design and data collection strategy accomplished its objectives. The intention is to offer guidance on how researchers, who are interested in the economic consequences of cancer, as well as of other chronic conditions, might develop and execute studies that examine labor market outcomes. As more attention is placed on the economic aspects of disease, the methods used to estimate productivity loss and other economic outcomes attributable to these conditions require careful scrutiny so that reliable findings can be used to shape health care decisions and policy.