Medical care
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The objective of this study is to quantify variation and variability in treatment of ductal carcinoma in situ (DCIS) over time and across registries of the Surveillance, Epidemiology, and End Results (SEER) program; to assess diffusion of treatments (breast-conserving surgery [BCS], BCS with radiotherapy, and mastectomy); and to identify correlates of treatment choice. ⋯ Findings indicate that diagnosis year and socioeconomic factors explain treatment choice for DCIS, but unexplained variation at the geographic-region level remains. Increasing variability in treatment implies continued uncertainty about optimal treatment of DCIS.
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Comparative Study
Race/ethnicity and the intensity of medical monitoring under 'watchful waiting' for prostate cancer.
Previous studies have found that racial/ethnic minority patients with prostate cancer are more frequently managed with "watchful waiting." Little, however, is known about the medical care received among men managed with watchful waiting. We examine the type and intensity of medical monitoring received by African American, Hispanic, and white patients with prostate cancer managed with "watchful waiting" in fee-for-service systems. ⋯ Regular medical monitoring is considered by most medical authorities to be a necessary component of management with watchful waiting. The disproportionately low receipt of medical monitoring visits and procedures observed for African American and Hispanic men managed with watchful waiting in this study suggest that there are racial/ethnic disparities in the receipt of appropriate prostate cancer management.
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Comparative Study
The effects of payment method on clinical decision-making: physician responses to clinical scenarios.
The influence of payment mechanisms on physician decisions is not well understood. ⋯ Payment mechanism has significant effects on clinical decision-making. Reduction of resources spent for discretionary care might be achieved under capitated arrangements; however, physicians respond with greater levels of discomfort under capitation than FFS.