The goal of this application is to study practice variations and outcomes across specialty type in Ovarian Cancer, and also to develop an approach for conducting chart review in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database that takes into consideration issues of patient confidentiality. In particular, the application will study how provider specialty influences surgery and chemotherapy, and how such differences influence mortality in Ovarian Cancer using multivariate counter-matching and conditional logistic regression, in order to control for chemotherapy and surgical treatment in a manner not previously accomplished. Counter-matching will allow for adjustment by factors such as age, patient co-morbidities, stage, year, chemotherapy (as determined from Medicare claims), and other provider information when appropriate, while utilizing the minimum number of pairs needed to detect important differences. Matching will be complemented with regression modeling using all available claims data in order to utilize maximum information available.
The aims of the application are to: (1) determine whether outcomes after chemotherapy differ with the specialty of the provider delivering that chemotherapy; (2) determine whether chemotherapy intensity differs across the specialty of the provider delivering that chemotherapy; (3) Determine whether survival is a function of the type of surgical specialist performing the primary cancer surgery; (4) study the referral patterns associated with different surgical specialties; and (5) develop a Phase-II """"""""minimally intrusive"""""""" approach that is sensitive to the concerns of forthcoming federal regulations regarding patient privacy, while at the same time allowing for important health services research questions to be answered using the data resources of the SEER-Medicare data base with chart review. We will propose a second phase of this research (not part of the present application), to examine those specific charts deemed interesting from this initial application or """"""""Phase-I"""""""" analysis. Our hope is that this study could serve as a model for other matched cohort studies involving chart review utilizing the SEER-Medicare database. ? ? ?
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