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Grant Details

Grant Number: 5R01CA134275-05 Interpret this number
Primary Investigator: Goodwin, James
Organization: University Of Texas Med Br Galveston
Project Title: Understanding Mechanisms of Ethnic Disparities in Colorectal Cancer Screening
Fiscal Year: 2012


Abstract

DESCRIPTION (provided by applicant): There is a rich literature documenting racial and ethnic disparities in the trajectory of cancer care and outcomes. Through analyses of tumor registry and Medicare data, the Principal Investigator and co-investigators have begun to uncover explanatory mechanisms or pathways underlying such disparities. We and others have identified disparities in survival after a diagnosis of cancer, much of which can be explained by delays in diagnosis leading to more advanced stage at diagnosis, and also by less than adequate treatment. There has also been considerable research on patient-level, physician level, and system- level factors that contribute to disparities in the trajectory of care. In this application we will conduct explanatory analyses with Medicare claims data to identify the mechanisms underlying racial disparities in stage of diagnosis of colorectal cancer (CRC), with a focus on the role of CRC screening among older adults. We will also develop methods to measure the performance of individual primary care physicians in providing CRC screening for patients. Of particular interest is how individual physicians' performance contributes to racial disparities in screening use. Aim 1: Determine the rate of screening for colorectal cancer in black and white men and women 65- 75 enrolled in fee for service Medicare in Michigan, New Jersey and Texas from 2001 through 2007. Aim 2: Determine the effect of other subject level (predisposing, enabling, and need) and environment level characteristics of CRC screening and determine the effect of continuity of care with a primary care physician (PCP) on receipt of CRC screening. Aim 3: Describe the variation among PCPs in use of CRC screening and determine how much of the race disparity in CRC screening is explained by PCP as opposed to patient characteristics. Aim 4: Examine the effects of provider characteristics (years in practice, age, volume of cases, primary specialty board certification, affiliation with academic medical centers, etc.) and medical system characteristics (PCPs per capita, gastroenterologists per capita) on the likelihood of CRC screening and also stratified by subjects' race. There are a number of options available to Medicare to promote health and reduce health disparities among its beneficiaries. The results of the mechanistic analyses in this application will allow for the design of interventions targeting the specific points in the trajectory of care that contribute to ethnic disparities in CRC screening. PUBLIC HEALTH RELEVANCE: In the U.S., colorectal cancer (CRC) is the fourth most frequently diagnosed but second leading cause of death among cancers. We will study Medicare data to understand better the reasons for racial disparities in CRC screening rates. With this information, Medicare will be able to design and implement interventions to promote health and reduce health disparities among its beneficiaries.



Publications

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy.
Authors: Baillargeon J. , Urban R.J. , Kuo Y.F. , Ottenbacher K.J. , Raji M.A. , Du F. , Lin Y.L. , Goodwin J.S. .
Source: The Annals of pharmacotherapy, 2014 Sep; 48(9), p. 1138-1144.
EPub date: 2014-07-02.
PMID: 24989174
Related Citations

Potentially inappropriate screening colonoscopy in Medicare patients: variation by physician and geographic region.
Authors: Sheffield K.M. , Han Y. , Kuo Y.F. , Riall T.S. , Goodwin J.S. .
Source: JAMA internal medicine, 2013-04-08; 173(7), p. 542-50.
PMID: 23478992
Related Citations

Primary care physicians and disparities in colorectal cancer screening in the elderly.
Authors: Singal A.K. , Lin Y.L. , Kuo Y.F. , Riall T. , Goodwin J.S. .
Source: Health services research, 2013 Feb; 48(1), p. 95-113.
EPub date: 2012-06-20.
PMID: 22716124
Related Citations

Many patients who undergo surgery for colorectal cancer receive surveillance colonoscopies earlier than recommended by guidelines.
Authors: Singh A. , Kuo Y.F. , Goodwin J.S. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2013 Jan; 11(1), p. 65-72.e1.
EPub date: 2012-08-16.
PMID: 22902760
Related Citations

Colonoscopist and primary care physician supply and disparities in colorectal cancer screening.
Authors: Benarroch-Gampel J. , Sheffield K.M. , Lin Y.L. , Kuo Y.F. , Goodwin J.S. , Riall T.S. .
Source: Health services research, 2012 Jun; 47(3 Pt 1), p. 1137-57.
EPub date: 2011-12-08.
PMID: 22150580
Related Citations

Predictors of colorectal cancer following a negative colonoscopy in the Medicare population.
Authors: Singh A. , Kuo Y.F. , Riall T.S. , Raju G.S. , Goodwin J.S. .
Source: Digestive diseases and sciences, 2011 Nov; 56(11), p. 3122-8.
EPub date: 2011-06-17.
PMID: 21681506
Related Citations

Trends in inpatient continuity of care for a cohort of Medicare patients 1996-2006.
Authors: Fletcher K.E. , Sharma G. , Zhang D. , Kuo Y.F. , Goodwin J.S. .
Source: Journal of hospital medicine, 2011 Oct; 6(8), p. 438-44.
PMID: 21990172
Related Citations

Overuse of screening colonoscopy in the Medicare population.
Authors: Goodwin J.S. , Singh A. , Reddy N. , Riall T.S. , Kuo Y.F. .
Source: Archives of internal medicine, 2011-08-08; 171(15), p. 1335-43.
EPub date: 2011-05-09.
PMID: 21555653
Related Citations

Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer.
Authors: Baillargeon J. , Kuo Y.F. , Lin Y.L. , Raji M.A. , Singh A. , Goodwin J.S. .
Source: Journal of the American Geriatrics Society, 2011 Jul; 59(7), p. 1268-73.
EPub date: 2011-07-07.
PMID: 21732924
Related Citations

Obesity and disability: relation among older adults living in Latin America and the Caribbean.
Authors: Al Snih S. , Graham J.E. , Kuo Y.F. , Goodwin J.S. , Markides K.S. , Ottenbacher K.J. .
Source: American journal of epidemiology, 2010-06-15; 171(12), p. 1282-8.
EPub date: 2010-05-14.
PMID: 20472569
Related Citations

Plasma cytokine levels in a population-based study: relation to age and ethnicity.
Authors: Stowe R.P. , Peek M.K. , Cutchin M.P. , Goodwin J.S. .
Source: The journals of gerontology. Series A, Biological sciences and medical sciences, 2010 Apr; 65(4), p. 429-33.
EPub date: 2009-12-16.
PMID: 20018825
Related Citations

Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care.
Authors: Raji M.A. , Kuo Y.F. , Freeman J.L. , Goodwin J.S. .
Source: Archives of internal medicine, 2008-10-13; 168(18), p. 2033-40.
PMID: 18852406
Related Citations




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