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Primary care physician continuity, survival, and end-of-life care intensity
Article indépendant
Objective: To examine the associations of primary care physician (PCP) care continuity with cancer-specific survival and end-of-life care intensity.
Data Sources: Surveillance, epidemiology, and end results linked to Medicare claims data from 2001 to 2015.
Study Design: Cox proportional hazards models with mixed effects and hierarchical generalized logistic models were used to examine the associations of PCP care continuity with cancer-specific survival and end-of-life care intensity, respectively. PCP care continuity, defined as having visited the predominant PCP (who saw the patient most frequently before diagnosis) within 6 months of diagnosis.
Data Extraction Methods: We identified Medicare patients diagnosed at age 66.5–94 years with stage-III or IV poor-prognosis cancer during 2001–2012 and followed them up until 2015. Patients who died within 6 months after diagnosis were excluded.
Principal Findings: Primary study cohort consisted of 85,467 patients (median survival 22 months), 71.7% of whom had PCP care continuity. Patients with PCP care continuity tended to be older, married, nonblack, non-Hispanic, and to have fewer comorbid conditions (p < 0.001 for all). Patients with PCP care continuity had lower cancer-specific mortality (adjusted hazard ratio: 0.93; 95% confidence interval [CI]: 0.91 to 0.95; p = 0.001) than did those without PCP care continuity. Findings of the 2001–2003 cohorts (nearly all of whom died by 2015) show no associations of overall end-of-life care intensity measures with PCP care continuity (adjusted marginal effects: 0.005; 95% CI: -0.016 to 0.026; p = 0.264).
Conclusions: Among Medicare beneficiaries with advanced poor-prognosis cancer, PCP continuity was associated with modestly improved survival without raising overall aggressive end-of-life care.
http://dx.doi.org/10.1111/1475-6773.13869
Voir la revue «Health services research»
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