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首页> 美国卫生研究院文献>Health Services Research >Prostate cancer treatment and ten-year survival among group/staff HMO and fee-for-service Medicare patients.
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Prostate cancer treatment and ten-year survival among group/staff HMO and fee-for-service Medicare patients.

机译：团体/职员HMO和付费医疗保险患者的前列腺癌治疗和十年生存率。

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OBJECTIVE: To compare treatment patterns and the ten-year survival of prostate cancer patients in two large, nonprofit, group/staff HMOs to those of patients receiving care in the fee-for-service health setting. DATA SOURCES/STUDY DESIGN: A cohort of men age 65 and over diagnosed with prostate cancer between 1985 and the end of 1992 and followed through 1994. Subjects (n = 21,741) were ascertained by two population-based tumor registries covering the greater San Francisco-Oakland and Seattle-Puget Sound areas. Linkage of registry data with Medicare claims data and with HMO inpatient utilization data allowed the determination of health plan enrollment and the measurement of comorbid conditions. Multivariate regression models were used to examine HMO versus FFS treatment and survival differences adjusting for sociodemographic and clinical characteristics. PRINCIPAL FINDINGS: Among cases with non-metastatic prostate cancer, HMO patients were more likely than FFS patients to receive aggressive therapy (either prostatectomy or radiation) in San Francisco-Oakland (odds ratio [OR] = 1.69, 95% CI = 1.46-1.96) but not in Seattle (OR = 1.15, 0.93-1.43). Among men receiving aggressive therapy, HMO cases were three to five times more likely to receive radiation therapy than prostatectomy. Overall mortality was equivalent over ten years (HMO versus FFS mortality risk ratio [RR] = 1.01, 0.94-1.08), but prostate cancer mortality was higher for HMO cases than for FFS cases (RR = 1.25, 1.13-1.39). CONCLUSION: Despite marked treatment differences for clinically localized prostate cancer, overall ten-year survival for patients enrolled in two nonprofit group/staff HMOs was equivalent to survival among patients receiving care in the FFS setting, even after adjustment for sociodemographic and clinical characteristics. Similar overall but better prostate cancer-specific survival among FFS patients is most plausibly explained by differences between the HMO and FFS patients in both tumor characteristics and unmeasured patient selection factors.
机译：目的：比较两种大型，非营利性，团体/职员HMO中前列腺癌患者的治疗方式和十年生存率，以及在有偿医疗条件下接受护理的患者的治疗模式和十年生存率。数据来源/研究设计：1985年至1992年底以及1994年之后的一组65岁及以上的男性被诊断出患有前列腺癌。受试者（n = 21,741）由覆盖整个旧金山的两个以人口为基础的肿瘤登记处确定-奥克兰和西雅图-普吉特海湾地区。将注册表数据与Medicare索赔数据以及HMO住院病人使用率数据链接在一起，可以确定健康计划的参与程度和合并症的测量。多变量回归模型用于检验HMO与FFS的治疗以及根据社会人口统计学和临床​​特征调整的生存差异。主要发现：在非转移性前列腺癌的病例中，HMO患者比FFS患者更有可能在旧金山-奥克兰接受积极治疗（前列腺切除术或放射治疗）（赔率[OR] = 1.69，95％CI = 1.46-） 1.96），但不在西雅图（OR = 1.15，0.93-1.43）。在接受积极治疗的男性中，HMO病例接受放射治疗的可能性是前列腺切除术的三到五倍。十年来的总死亡率是相等的（HMO与FFS死亡率风险比[RR] = 1.01，0.94-1.08），但是HMO病例的前列腺癌死亡率高于FFS病例（RR = 1.25，1.13-1.39）。结论：尽管在临床上局限性前列腺癌的治疗上存在显着差异，但即使在调整了社会人口统计学和临床​​特征后，参加两个非营利性组织/员工HMO的患者的总体十年生存期仍与在FFS设置中接受治疗的患者的生存期相当。在HFS和FFS患者之间，在肿瘤特征和未测量的患者选择因素方面的差异，最有可能解释了FFS患者之间总体相似但更好的前列腺癌特异性生存。

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