Reducing Cancer Costs Through Symptom Management and Triage Pathways.

Purpose: Value-based care infers care that is high quality at a comparatively low total cost. A key strategy for value-based oncology care is to avoid unnecessary emergency room (ER) visits and associated hospitalizations of patients receiving treatment for cancer. Early experience with this strategy showed that symptom management in patients with cancer can result in the reduction of ER events and hospitalizations.

The intersection of gender and race/ethnicity in smoking behaviors among menthol and non-menthol smokers in the United States.

Aims: To determine whether menthol is related to initiation, quantity or quitting, we examined differences in smoking behaviors among menthol and non-menthol smokers, stratified by gender and race/ethnicity, and adjusting for age, income and educational attainment.

Design: Cross-sectional, using data from the 2005 National Health Interview Survey and Cancer Control Supplement.

Setting: United States.

Prometheus payment model: application to hip and knee replacement surgery.

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs.

Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey.

To inform current debates over whether occupational class is causally linked to health inequities, the authors used data from the 2000 U.S. National Health Interview Survey to compare occupational disparities in access to health services, socioeconomic resources, and health status, using (1) the United Kingdom's new National Statistics Socio-Economic Classification (NS-SEC), premised on type of labor contract (salaried vs.

Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000.

Objectives: We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures.

Methods: We analyzed data from the 2000 National Health Interview Survey.

Results: Overall, the prevalence of current smoking was greatest among persons in--and independently associated with--working class jobs, low educational level, and low income.

Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--the public health disparities geocoding project (US).

Objectives: To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States.

Methods: Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6016425) or Rhode Island (RI; 1990 population = 1003464) for: STIs (MA: 1994-1998, n = 26535 chlamydia, 7464 gonorrhea, 2619 syphilis; RI: 1994-1996, n = 4473 chlamydia, 1256 gonorrhea, 305 syphilis); TB (MA: 1993-1998, n = 1793; RI: 1985-1994, n = 576), and non-fatal weapons related injuries (MA: 1995-1997, n = 6628).

Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.

Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989-1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988-1992: 140,610 resident cases in Massachusetts; 1989-1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.