RT Journal
A1 Greenberg CC, Lipsitz SR, Neville B, et al
T1 REceipt of appropriate surgical care for medicare beneficiaries with cancer
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD October 1
VO 146
IS 10
SP 1128
OP 1134
DO 10.1001/archsurg.2011.141
UL http://dx.doi.org/10.1001/archsurg.2011.141
AB Objective 
                  To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer.Design 
                  Retrospective cohort study.Setting 
                  National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data.Patients 
                  Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007.Main Outcome Measures 
                  Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital.Results 
                  Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvant therapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest.Conclusions 
                  We found a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.