Measuring colorectal cancer care quality for the publicly insured in N ew Y ork S tate

The extent to which concordance with colorectal cancer treatment quality metrics varies by patient characteristics in the publicly insured is not well understood. Our objective was to evaluate the quality of colorectal cancer care for publicly insured residents of New York State ( NYS ). NYS cancer registry data were linked to M edicaid and M edicare claims and hospital discharge data. We identified colorectal cancer cases diagnosed from 2004 through 2006 and evaluated three treatment quality measures: adjuvant chemotherapy within 4 months of diagnosis for American Joint Cancer Committee ( AJCC ) stage III colon cancer, adjuvant radiation within 6 months of diagnosis for AJCC stage IIB or III rectal cancer, and adjuvant chemotherapy within 9 months of diagnosis for AJCC stage II–III rectal cancer. Concordance with guidelines was evaluated separately for M edicaid‐enrollees under age 65 years and M edicare‐enrollees aged 65–79 years. For adjuvant chemotherapy for colon cancer, 79.4% (274/345) of the M edicaid cohort and 71.8% (585/815) of the M edicare cohort were guideline concordant. For adjuvant radiation for rectal cancer, 72.3% (125/173) of the M edicaid cohort and 66.9% (206/308) of the M edicare cohort were concordant. For adjuvant chemotherapy for rectal cancer, 89.5% (238/266) of the M edicaid cohort and 76.0% (392/516) of the M edicare cohort were concordant. Younger age was associated with higher adjusted odds of concordance for all three measures in the M edicare cohort. Racial differences were not evident in either cohort. There is room for improvement in concordance with accepted metrics of cancer care quality. Feedback about performance may assist in targeting efforts to improve care.