Cancer Screening and Care for AIANs in Washington State

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Cancer Screening and Care for AIANs in Washington
State

• Scott Ramsey
• Fred Hutchinson Cancer Research Center

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Cancer care disparities

• Case studies suggest for AIANs
• Less access to screening services (mammography,
  colonoscopy)
• Diagnosed at later cancer stages (harder to
  treat)
• May drop out of cancer care before its completed
• We dont have hard data looking at patterns of
  cancer care to show the disparities
• We need to call attention to the details of the
  disparities to get funding to reduce them

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Documenting the problem

• First step
• Examine Washington State Cancer Registry records
• AIAN vs. non-AIAN
• Medicaid vs. non-Medicaid

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Ongoing project Cancer Care for AIAN

• Access
• Did the patient get the right treatment?
• Did it happen at the right time?
• Was treatment of sufficient duration?
• Outcomes
• How does survival for AIANs compare to non-
• AIANs with the same cancer (and cancer stage
  at diagnosis)?

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How will we get the data?

• Partnership with Northwest Portland Area Indian
  Health Board
• NW Tribal Registry Project
• Combine data from three sources
• Northwest Tribal Registry
• The WA State Cancer Registry
• The WA State Medicaid claims database

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Objective of the linkage

• A dataset of all cancer care services for AIAN
  patients paid for by Washington State Medicaid
• Can analyze patterns of cancer care for AIANs (in
  WA) and compare to the non-AIAN Medicaid cancer
  patients

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Confidentiality maintained

• Names used only to link up the data
• After the link, names are removed
• No other identifying information either
• Analyses will look at Native patients in WA as a
  group
• No comparing of tribes

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Early Results
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48 of AIAN with cancer enrolled in Medicaid at
or following diagnosis 12 of non-AIAN enrolled
at or following diagnosis
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Time from diagnosis to surgery (months)
Washington State, 1997-2003
Breast - Local/Regional Lung -
Local/Regional Colorectal - Local/Regional
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Planned analyses

• of patients receiving appropriate treatment
• How distance to provider affects quality of
  cancer care
• Survival (when possible)

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Future directions

• Look at cancer care for AIANs who arent enrolled
  in Medicaid
• IHS contract health service providers
• Look at use of cancer screening for AIANs
• New NCI-funded project starting Summer 2007
• Expand analysis to Oregon and California
• Includes interviews of Native cancer survivors,
  to be conducted by NPAIHB

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Timeline

• Winter 2006
• Screening analysis project was approved by
  resolution by the NPAIHB delegates
• Spring 2007
• Acquiring updated cancer diagnosis information
  (including 2004 diagnoses) and Medicaid data for
  Washington State
• Summer 2007
• Completing IRB and data use applications to
  acquire data from Idaho and Oregon cancer
  registries for linkage with RPMS data

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Questions? Concerns?