Hospice Use. The linked SEER-Medicare database will be analyzed to examine the sociodemographic (e.g., age, sex, race or ethnicity, income, education) and health care (e.g., HMO status) determinants of hospice use among beneficiaries with colorectal and lung cancer (diagnosed in 1992 and 1993). The hospice benefit was originally designed as an alternative to aggressive care for beneficiaries with terminal illnesses. Few studies, however, have examined the utilization and cost of health care services among hospice patients. This study will assess the level and type of services both prior to and during hospice care (R. Mentnech, Health Care Financing Administration, personal communication to Maria Hewitt, November 1998.).
Research Related to Payment Issues. Patterns of care and volume stability at the physician organization level will be studied using per capita measures of utilization for selected oncology services and for all Medicare services. The effect of the principal provider organization's characteristics, size, and case mix of oncology practice, as well as geographic location, on per capita costs will also be examined. These analyses will support the development of alternative service bundles and carve-out payments for the care of Medicare cancer patients. The linked SEER-Medicare database will be the principal source of data. The project is in the early development phase (USDHHS, 1998).
Research Training and Development. In an effort to promote research using its databases, HCFA has created the Research Data Assistance Center (ResDAC) to assist new researchers and promote familiarity with and use of its databases for research on Medicare and Medicaid issues. The initial ResDAC contract is with the University of Minnesota, which has formed a consortium with Boston University, Dartmouth College, and Georgetown University. ResDAC will facilitate and expedite the use of HCFA data for research on Medicare and Medicaid by providing education and training, improving researcher access to HCFA data, and providing expert consultation for researchers (USDHHS, 1998).
Extramural Research. According to the HSRProj database, HCFA has sponsored one extramural health services research project, "Estimating Mammography Utilization by Elderly Medicare Women."
Most of the cancer-related health services research supported by CDC is funded through the National Center for Chronic Disease Prevention and Health, Division of Cancer Prevention and Control. The division plans and conducts epidemiologic studies and evaluations to identify the feasibility and effectiveness of cancer prevention and control strategies. Other activities include providing technical assistance to states, local public health agencies, and other health care provider organizations. Ongoing extramural research supported by the Division of Cancer Prevention and Control is shown in Box 7.8.