The purpose of this study is to examine the effects of the Balanced Budget Act of 1997 (BBA) on home health service utilization, costs, and outcomes on older adults with cancer. The study will use the Surveillance, Epidemiology and End Results (SEER)-Medicare database to address four specific aims. These include: 1) Assess the effect of the BBA on home health service utilization, including use, number of visits, and duration of services for older cancer patients; 2) Estimate the effect of the BBA on substitutes or complements for home health services in older adults with cancer; 3) Estimate the effect of the BBA on costs associated specifically with home health services and on total costs of care in older cancer patients; and 4) Determine the effect of the BBA on the incidence of adverse outcomes in older adult cancer patients. The SEER-Medicare Database is a linkage of the Surveillance, Epidemiology and End Results Program of the NCI, a population-based cancer registry that collects demographic, clinical, and follow-up data for vital status for persons with cancer, and the Medicare claims data for covered health services for individuals from the point of eligibility to death. The SEER data currently includes approximately 25% of the population and is comparable to the US population in terms of age and sex distribution for persons 65 and older. The analytic approach will compare home health service utilization, costs, and outcomes among patients who are diagnosed at different points of time with respect to enactment and implementation of the BBA. The significance of this project lies in the evidence it will provide regarding the quality and cost of home health care for older cancer patients before and after implementation of the BBA. Data generated from this study can be used to guide federal decision makers in formulating policies related to home health services for older cancer patients.
| Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A et al. (2009) The effects of the Balanced Budget Act of 1997 on home health and hospice in older adult cancer patients. Med Care 47:279-85 |
| Locher, Julie L; Kilgore, Meredith L; Morrisey, Michael A et al. (2006) Patterns and predictors of home health and hospice use by older adults with cancer. J Am Geriatr Soc 54:1206-11 |
