Understanding Variations in the Quality of Cancer Care for Older Adults with Large Sources of National Health Data

Delivering high-quality health care to the growing population of older adults diagnosed with cancer presents a myriad of patient-level and system-level challenges. Patient-reported health care experiences and unintended service use are promising outcomes to inform improvements in coordination of care and potential barriers to accessing evidence-based care. There is little empirical evidence of the clinical and behavioral factors that influence the delivery of necessary health services in older adults diagnosed with hematologic malignancies (e.g., leukemia and lymphoma). Additionally, the incidence of complex pain syndromes in adults with cancer is growing; some patients receive gabapentinoid medications (the drugs gabapentin and pregabalin) despite meager evidence for long-term safety and efficacy. The purpose of this dissertation is to describe factors influencing patient-reported health care experiences, emergency department use, and trends in gabapentinoid prescription in cohorts of adults diagnosed with cancer in the US. This dissertation consists of three manuscripts: Manuscript 1 and 2 use data from the Surveillance, Epidemiology, and End-Results Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS®) resource; Manuscript 3 uses data from the Medical Expenditure Panel Survey (MEPS). Multiple linear and logistic regression and are the primary analytic approaches of this dissertation. The findings of this dissertation will be crucial for informing potential policy-relevant strategies, coordination of care interventions, and future prospective research on gabapentinoid medication efficacy. Further, examining the unaddressed health service needs for these populations will lead to a program of research focused on building and evaluating models of care that improve access, coordination, and outcomes of adults diagnosed with hematologic malignancies and/or complex pain syndromes.PhDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/162826/1/ajfau_1.pd