Is care coordination associated with improved care quality for comorbid conditions in cancer survivors?

Abstract

6026 Background: Many cancer survivors have comorbid conditions, adding complexity to their already complicated care and requiring greater care coordination. We assessed the role of care coordination in comorbid condition care for cancer survivors. Methods: Using SEER-Medicare, we examined 7 published indicators of quality comorbid condition care in survivors of loco-regional breast, prostate, or colorectal cancer who were diagnosed in 2004, in fee-for-service Medicare, and survived ≥3 years. Comorbid condition care was evaluated during the transition from initial cancer treatment to survivorship (i.e. days 366-1095 post-diagnosis). Coordination risk was categorized as Likely, Possible, or Unlikely using an index developed and tested as part of the ACG case-mix adjustment and predictive modeling tool. The index factors in the number of unique providers, number of specialties, the percentage majority source of care, and generalist visits. We tested the hypothesis that lower coordination risk would be associated with better comorbid condition care using logistic regression, adjusting for socio-demographics, cancer type, and comorbidity. Results: The sample included 8661 survivors (53% prostate, 22% breast, 26% colorectal; mean age 75; 65% male, 85% white). Our hypothesis was not supported. Compared to patients with Unlikely coordination issues, patients with Likely coordination issues were more likely to receive appropriate care on 4 indicators and less likely on 1. Possible coordination issues were associated with better care on 1 indicator and worse care on 1 indicator. To explore this finding further, we conducted post-hoc analyses examining the role of each component of the coordination risk index. Having more unique providers was generally associated with better comorbid condition care, in contrast to the calculation of the index which considers more unique providers a greater risk for coordination issues. Conclusions: These findings suggest that traditional metrics of care coordination may not be valid for survivors of cancer. Understanding the role of care coordination in cancer survivorship care requires development and application of alternative coordination measures.