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Article Title

Characterizing Longitudinal Patterns of Breast Cancer Care

Publication Date

4-30-2015

Keywords

electronic health records, care patterns

Abstract

Background/Aims: Cancers with high rates of survival, e.g. breast cancer, are often characterized by treatment periods, or episodes of care, that can continue intermittently for months or years. The effective beginning of a cancer care episode may precede the date a patient obtains a definitive diagnosis. The peridiagnosis phase is often a time of intense resource use that may involve patients seeking care or physician opinions at multiple health care organizations. After the initial episode of treatment, which may involve multiple interventions and cycles, routine posttreatment surveillance may continue indefinitely. Considering the extended length of breast cancer treatment and follow-up, the electronic health record (EHR) for one or more organizations may reflect only part of the long-term care of these patients. In this study we characterize longitudinal patterns of breast cancer care across two health care organizations using a linked EHR database.

Methods: We studied a cohort of 13,377 women with evidence of some breast cancer care, 2000–2013. We distinguished breast cancer-related treatment from other types of care, e.g. diagnosis, second opinions, surveillance. We developed an algorithm to define the customary cancer care periods (routine screening, peridiagnosis, treatment, posttreatment surveillance). We determined number of care episodes for each patient and classified each patient as receiving care at either or both of the health care organizations.

Results: Care period classification identified a subsample of 7,365 patients who received treatment for breast cancer, the rest of the cohort were seen only for diagnosis or posttreatment surveillance. Among those treated, 17% had more than one treatment episode and 16% of patients sought care at both organizations. We present details of our classification algorithms and other key findings.

Discussion: By examining specific components of the cancer care episode, we can assess whether breast-related services were provided concurrently or sequentially, and before, during or after the initial diagnosis period. Categorizing cancer-related services by purpose and time offers valuable insights into how care is organized and delivered.

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