ures for adolescents, aspects of clinician-patient interactions that improve patient satisfaction and outcomes) (Elaine Power, AHCPR, personal communication to Maria Hewitt, May 1998).

Research on Managed Care. To evaluate the effect of particular managed care policies on the quality of care provided to patients with chronic diseases (e.g., protocols governing the referral of patients to medical specialists, arrangements for paying physicians), AHCPR, in collaboration with HRSA (which is also part of DHHS) and the American Association of Health Plans Foundation, has recently funded a three-year research program. None of the conditions under study are cancers, but findings may be generalizable to cancer (www.ahcpr.gov/news/press/aahppr.htm).

Technology Assessment. AHCPR staff have evaluated the effectiveness of several cancer-related technologies including autologous peripheral stem cell transplantation, hematopoietic stem cell transplantation in multiple myeloma, and cryosurgery for recurrent prostate cancer following radiation therapy.

Health Care Financing Administration

Intramural ResearchOffice of Strategic Planning. Patterns and Outcomes of Cancer Care in the Medicare Population. HCFA analysts are attempting to answer the following questions with the linked SEER-Medicare database:

  • What are overall Medicare costs, by type and stage of cancer?
  • What Medicare costs are specifically related to cancer care?
  • What comorbidities are associated with cancer and how do they influence Medicare use and cost?
  • What is the mix of care (on a per-person basis) among community hospitals, teaching hospitals, and cancer centers?
  • What institutional factors influence the type of inpatient hospital care received by cancer patients?

Breast Cancer Treatment Patterns Among Medicare Enrollees in HMOs and FFS. The linked SEER-Medicare database has recently been analyzed to examine the use of breast conserving surgery (BCS) versus mastectomy for early-stage breast cancer cases in HMOs and FFS. The study also compared the distributions of stage at diagnosis between HMO and FFS enrollees and examined the use of adjuvant radiation therapy among BCS patients. The study included all early-stage breast cancer cases diagnosed in 1988-1993 among elderly women entitled to Medicare residing in SEER reporting areas. (USDHHS, 1998; Riley et al, 1999).

Mammography Utilization Initiative. Rates of mammography use have been published by age and race, at the state and county levels, for 1993. The mammography use data book will be updated with 1994 and 1995 Medicare data and disseminated to public health and cancer organizations to help target outreach activities to areas with particularly low utilization. The data will be placed on HCFA's Internet home page (USDHHS, 1998).

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