The Disenrollment Pilot Study, funded by
a CRN administrative supplement, has completed analyses. Ultimately,
we identified 132,590 enrollees in five HMOs who were diagnosed with
invasive cancer from 1993 to 1999. Among those patients who remained
alive at one year after diagnosis, 96% were still enrolled in their
health plan. Among 5-year survivors, 84% remained enrolled. There was
little variability in retention rates across the five plans and across
the major cancers. These high retention rates encourage us to believe
that the CRN can serve as a base for studies of quality of care and
long-term outcomes. A complete report from the study will be available
on the CRN website later this year. A summary manuscript detailing the
results has been accepted for publication in the Journal of the National
Cancer Institute.
Within this study we also focused on identifying characteristics of
cancer patients associated with disenrollment during initial treatment,
defined as the first year following diagnosis. Patients with the highest
rates of disenrollment during this period were aged 20 to 44 years,
non-white, or had short lengths of enrollment prior to their cancer
diagnosis. Patients insured through Medicaid had the highest disenrollment
rate. This suggests greater loss to follow-up for quality of care studies
in these groups, although in most sub-groups retention rates were over
90% . Table 1 presents the results for several groups of patients.
The sub-groups with the highest rates of disenrollment were of special
concern since these are the groups most often found to lose health insurance
in surveys of the general public.
|
|
|
% Disenrolled
|
Adjusted
Hazard Ratio*
|
95% CI For Adjusted Hazard Ratio
|
|
Age
|
20-44 |
7.4
|
1.9
|
1.7, 2.1
|
| 45-54 |
4.0
|
1.3
|
1.0, 1.4
|
| 55+ |
1.0
|
1.0
|
referent
|
|
Race
|
Asian |
4.4
|
1.3
|
1.1, 1.5
|
| African-American |
3.4
|
1.2
|
1.1, 1.3
|
| Hispanic |
3.6
|
1.1
|
0.95, 1.2
|
| Non-Hispanic White |
2.7
|
1.0
|
referent
|
| Other/Unknown |
6.7
|
1.8
|
1.4, 2.3
|
Primary
Type
of Insurance |
Medicaid |
16.5
|
3.5
|
2.9, 4.3
|
| Commercial |
4.0
|
1.5
|
1.4, 1.6
|
| Self-pay |
2.9
|
1.2
|
1.1, 1.4
|
| Medicare |
1.7
|
1.0
|
referent
|
*Controlling for age, sex, race, stage of cancer, prognosis,
enrollment prior to diagnosis, CRN site, and year of diagnosis, censored
at date of death or end of first year after diagnosis if still enrolled.
To follow-up on this issue, five CRN sites have submitted a proposal
to the National Cancer Institute to interview both newly diagnosed cancer
patients who disenroll from their health plan during the first year and
a comparison group who remain enrolled.
Several developments that grew out of the pilot study may be of special
interest to CRN investigators and staff:
Using compiled tumor registry data from multiple sites, we developed
and tested a "cancer counter." An updated version of the cancer
counter, including data from all of the CRN-related tumor registries,
is under construction and will be available on the CRN website later in
the year.
The counter will support development of proposals by assisting investigators
to estimate sample sizes and describe samples in terms of characteristics,
such as, age, race and gender.
The study used a detailed data dictionary that included data elements
from the sites' tumor registries and electronic enrollment and vital status
databases. Multiple crosssite tests of missing data and crosstabulations
provided investigators and data analysts with better understanding of
the inconsistencies and special problem areas that arise in merging frequently
used data elements across sites. Thus, the study served as a pilot for
the data-mapping initiative being conducted as a key element of CRN II
- Terry Field, Meyers Institute
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