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Biomedical subjects

G Katterhagen

Publications and source records attributed to G Katterhagen.

5 recordsLinked to original sources
PubMed2001

Breast cancer outcomes among older women: HMO, fee-for-service, and delivery system comparisons.

OBJECTIVE: To analyze the relationship of health insurance status and delivery systems to breast cancer outcomes--stage at diagnosis, treatment selected, survival--focusing on comparisons among women aged 65 or more having Medicare alone, Medicare/Medicaid, or Medicare with group model HMO, non-group model HMO, or private fee-for-service (FFS) supplement. DESIGN: Retrospectively defined cohort from Sacramento, Calif, regional cancer registry. SETTING: Thirteen-county region in northern California with mature managed care market. PATIENTS: Female invasive breast cancer patients aged 65 or more (N = 1,146), diagnosed 1987-1993. MEASUREMENTS AND MAIN RESULTS: Health insurance was determined from hospital records. Outcomes were analyzed with multivariate regression models, controlling for age, ethnicity, time, and SES measures. Stage I diagnosis was more likely among group model HMO patients than among private FFS insured (odds ratio [OR], 1.42; 95% confidence interval [CI], 0.84 to 2.40). Stage I tumors were significantly less likely for Medicaid patients (OR, 0.50; 95% CI, 0.31 to 0.82). Use of breast-conserving surgery plus radiation (BCS+) varied significantly by hospital type (including HMO-owned and various-sized community hospitals) and time. Survival of patients with private FFS, group-, and non-group model HMO insurance was not significantly different, but was for those with Medicaid or Medicare alone. CONCLUSIONS: This study sheds new light on the relationship of insurance to stage and survival among older breast cancer patients, highlighting the importance of distinguishing types of HMOs and types of FFS plans. These outcomes do not differ significantly between women with Medicare who are in HMOs and those with private FFS supplemental insurance. However, patients with Medicare/Medicaid or Medicare alone are at risk for poorer outcomes.

Aged↗
PubMed2000

The relationship of HMOs, health insurance, and delivery systems to breast cancer outcomes.

BACKGROUND: The current climate of anger and frustration with managed care has heightened interest in the quality of health care provided by managed-care plans, particularly health maintenance organizations (HMOs). This breast cancer outcomes study, investigating relationships of health insurance and delivery systems to stage at diagnosis, treatment selected, and survival, is based in a heavily penetrated, highly competitive HMO market. METHODS: Data for 1,788 residents of northern California younger than 65 years of age at diagnosis (1987-1993) were provided by a population-based cancer registry. Patient insurance included fee-for-service (FFS), group-model HMO, nongroup HMO, publicly insured, and uninsured. Diagnosis and treatment occurred in 73 hospitals (large, medium/moderately small, or very small community, rural, teaching, or HMO-owned hospitals). Regression models examined relationships of insurance and hospital type to 3 outcomes (stage, treatment, and survival), controlling for age, ethnicity, education, neighborhood occupational class, and time period. RESULTS: Early diagnosis was as likely for group-model and nongroup-model HMO-insured patients as for the private FFS-insured patients. In 1987-1990, HMO-owned hospitals were leaders in treating 46% of early-stage breast cancers with breast-conserving surgery plus radiation (BCS+); by 1991-1993, the most significant increases in BCS+ use occurred at teaching and large community hospitals. Survival of group-model HMO, nongroup-model HMO, and FFS patients was not significantly different. Publicly insured/uninsured patients had more stage III/IV disease (OR=2.01, P = 0.006) and greater all-cause mortality (risk ratio 1.46, P = 0.015). CONCLUSIONS: Group-model and nongroup-model HMO patients are similar to FFS-insured patients in stage at diagnosis and survival outcomes. Treatment selection is related to hospital type rather than insurance coverage.

Breast Neoplasms↗
PubMed1996

Physician compliance with outcome-based guidelines and clinical pathways in oncology.

Outcome-based guidelines and clinical pathways in oncology were developed, implemented, and evaluated in two open-staffed community hospitals in California. These guidelines and paths were instituted in both the ambulatory and in-patient setting. Evaluation demonstrated a positive impact of these tools on outcomes and a corresponding reduction in costs. The success of a program of guidelines and clinical paths is contingent on a number of factors; however, the key to success is the meaningful involvement of physicians. Suggestions for ensuring this physician collaboration, based on our experience, are detailed.

Critical Pathways↗
PubMedDate not supplied

Immunoaugmentative therapy. A primer on the perils of unproved treatments.

Immunoaugmentative therapy is an unproved cancer treatment that until recently was offered to patients by zoologist Lawrence Burton, PhD, at a facility in Freeport, Bahamas. The therapy consists of serum measurements of certain "immune deficiencies" and purportedly restores immune function by injection of products variously derived from tumor tissue and blood from individuals with cancer and healthy volunteers. Immunoaugmentative therapy represents a potentially serious public health risk, since it is capable of transmitting hepatitis B and the presumed etiologic agent for the acquired immunodeficiency syndrome. Physicians and health officials who learn of patients receiving this therapy are advised that its efficacy remains unproved and that the risk of receiving contaminated blood products is considerable.

Abscess↗