Steven T Fleming
Biographic Data
| ID | 5536334 |
|---|---|
| NAME | Steven T Fleming |
| GIVEN NAMES | Steven T |
| FAMILY NAME | Fleming |
| SIGNATURE | FLEMING S T |
| AFFILIATIONS | University of Kentucky |
| VERIFIED | No |
| TOTAL WORKS | 15 |
| TOTAL CITATIONS | 0 |
| WORKS AS AUTHOR | 15 |
| WORKS AS EDITOR | 0 |
| FIRST PUBLICATION YEAR | 1988 |
| LATEST PUBLICATION YEAR | 2016 |
| H-INDEX | 0 |
Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants
BACKGROUND: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-…
Disparities in Colorectal Cancer Treatment Delay Within Appalachia—The Role of For‐Profit Hospitals
BACKGROUND: Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined. OBJECTIVE: This study identified the source of this disparity in treatment del…
The Relationship Between Perceived Burden of Chronic Conditions and Colorectal Cancer Screening Among Appalachian Residents
PURPOSE: As the population living with several concurrent chronic conditions or multiple morbidity (MM) increases, understanding how to effectively fit prevention efforts into disease management becomes more important, particularly among rural, underserved populations. Compared to their urban counterparts, rural residents suffer higher rates of disease, receive fewer preventive services, and often live in environments limiting access to optimal m…
Clinical, Sociodemographic, and Service Provider Determinants of Guideline Concordant Colorectal Cancer Care for Appalachian Residents
BACKGROUND: Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer. METHODS: Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Car…
Treatment Patterns for Prostate Cancer
BACKGROUND: As evidence-based guidelines increasingly define standards of care, the accurate reporting of patterns of treatment becomes critical to determine if appropriate care has been provided. We explore the level of agreement between claims and record abstraction for treatment regimens for prostate cancer. METHODS: Medicare claims data were linked to medical records abstraction using data from the Centers for Disease Control and Prevention's…
Impact of Non-HIV Related Comorbidities on Retention in HIV Medical Care
Developing a Claim-based Version of the ACE-27 Comorbidity Index
OBJECTIVES: The adult comorbidity evaluation (ACE-27) is a medical record-based comorbidity index that predicts survival among various types of cancer patients. The purpose of this study was to compare the medical record-based ACE-27 instrument to a newly developed administrative claim-based ACE-27 measure. STUDY DESIGN AND SETTING: Cross-sectional study of 4,300 breast and prostate cancer patients from the Centers for Disease Control and Prevent…
Data Sources for Measuring Comorbidity
Comorbidity as a Predictor of Stage of Illness for Patients With Breast Cancer
OBJECTIVE: The purpose of this research was to determine whether comorbidity affects the stage at which breast cancer is diagnosed. METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) was merged with Medicare claims for 17,468 women diagnosed with breast cancer from 1993 to 1995. RESULTS: Women with cardiovascular disease, musculoskeletal disorders, mild-to-moderate gastrointesti…
A Comprehensive Prognostic Index to Predict Survival Based on Multiple Comorbidities
BACKGROUND: The presence of comorbidities often influences clinical decision-making, although many studies exclude patients with comorbid disease for the sake of analysis. OBJECTIVES: The purpose of this study was to develop a Comprehensive Prognostic Index (CPI), designed specifically for breast cancer patients. RESEARCH DESIGN: This study linked Medicare claims with the Kentucky Cancer Registry and developed two models based on 1 year survival;…
Interpreting the Health Care Financing Administrationʼs Mortality Statistics
In this article, the methodology used by the Health Care Financing Administration in the 1992 release of 1990 mortality statistics is described, and the performance of one outlier hospital is evaluated as a case study. The study hospital is compared to all other hospitals, and to a smaller cohort of 200-to-299-bed minor teaching hospitals, in terms of predicted and observed mortality rates and mortality model determinants. Proportionately more pa…
The Impact of Diagnosis Related Group Profitability on the Skimming and Dumping of Psychiatric Diagnosis Related Groups
Psychiatric DRGs are identified in terms of their relative profitability within each hospital of a 386 hospital cohort. It is then determined whether hospitals admitted more of the more profitable and fewer of the less profitable patients over the period 1983-1987 (skimming). Also determined is whether hospitals discharged more of the less profitable to other short term hospitals over that same period of time (dumping). The findings generally ind…
The Measurement of Mortality
This paper describes the development of risk-adjusted mortality indices (RAMI) using 1985 MEDPAR data from 657 hospitals. The RAMI methodology is adopted from the Commission on Professional and Hospital Activities, however, both inhospital and post-discharge deaths are counted within time windows that vary by clinical condition. Five different RAMI measures (expected deaths/observed deaths) are developed, compared, and aggregated into various hos…
Should DRG Assignment Be Based on Age
The present Medicare Diagnosis Related Group (DRG) classification system contains 95 DRG pairs, where one DRG of the pair contains patients within a distinct diagnostic category who are under 70 years of age with no comorbidities or complications (CCs). The other DRG of the pair contains patients in the same diagnostic category who are over 69 or who have CCs. This study examines whether it is appropriate for reimbursement purposes to group those…
The Risk-Adjusted Mortality Index
The Commission on Professional and Hospital Activities (CPHA) developed the Risk-Adjusted Mortality Index (RAMI), a method for comparing hospital death rates using existing abstract or billing data. The method is comprehensive insofar as it includes all payers and all types of cases except neonates. RAMI was designed to differentiate among admissions on the basis of the patient characteristics that increase or reduce the risk of dying in the hosp…
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Should DRG Assignment Be Based on Age
The present Medicare Diagnosis Related Group (DRG) classification system contains 95 DRG pairs, where one DRG of the pair contains patients within a distinct diagnostic category who are under 70 years of age with no comorbidities or complications (CCs). The other DRG of the pair contains patients in the same diagnostic category who are over 69 or who have CCs. This study examines whether it is appropriate for reimbursement purposes to group those…
The Risk-Adjusted Mortality Index
The Commission on Professional and Hospital Activities (CPHA) developed the Risk-Adjusted Mortality Index (RAMI), a method for comparing hospital death rates using existing abstract or billing data. The method is comprehensive insofar as it includes all payers and all types of cases except neonates. RAMI was designed to differentiate among admissions on the basis of the patient characteristics that increase or reduce the risk of dying in the hosp…
The Measurement of Mortality
This paper describes the development of risk-adjusted mortality indices (RAMI) using 1985 MEDPAR data from 657 hospitals. The RAMI methodology is adopted from the Commission on Professional and Hospital Activities, however, both inhospital and post-discharge deaths are counted within time windows that vary by clinical condition. Five different RAMI measures (expected deaths/observed deaths) are developed, compared, and aggregated into various hos…
The Impact of Diagnosis Related Group Profitability on the Skimming and Dumping of Psychiatric Diagnosis Related Groups
Psychiatric DRGs are identified in terms of their relative profitability within each hospital of a 386 hospital cohort. It is then determined whether hospitals admitted more of the more profitable and fewer of the less profitable patients over the period 1983-1987 (skimming). Also determined is whether hospitals discharged more of the less profitable to other short term hospitals over that same period of time (dumping). The findings generally ind…
Interpreting the Health Care Financing Administrationʼs Mortality Statistics
In this article, the methodology used by the Health Care Financing Administration in the 1992 release of 1990 mortality statistics is described, and the performance of one outlier hospital is evaluated as a case study. The study hospital is compared to all other hospitals, and to a smaller cohort of 200-to-299-bed minor teaching hospitals, in terms of predicted and observed mortality rates and mortality model determinants. Proportionately more pa…
A Comprehensive Prognostic Index to Predict Survival Based on Multiple Comorbidities
BACKGROUND: The presence of comorbidities often influences clinical decision-making, although many studies exclude patients with comorbid disease for the sake of analysis. OBJECTIVES: The purpose of this study was to develop a Comprehensive Prognostic Index (CPI), designed specifically for breast cancer patients. RESEARCH DESIGN: This study linked Medicare claims with the Kentucky Cancer Registry and developed two models based on 1 year survival;…
Comorbidity as a Predictor of Stage of Illness for Patients With Breast Cancer
OBJECTIVE: The purpose of this research was to determine whether comorbidity affects the stage at which breast cancer is diagnosed. METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) was merged with Medicare claims for 17,468 women diagnosed with breast cancer from 1993 to 1995. RESULTS: Women with cardiovascular disease, musculoskeletal disorders, mild-to-moderate gastrointesti…
Data Sources for Measuring Comorbidity
Developing a Claim-based Version of the ACE-27 Comorbidity Index
OBJECTIVES: The adult comorbidity evaluation (ACE-27) is a medical record-based comorbidity index that predicts survival among various types of cancer patients. The purpose of this study was to compare the medical record-based ACE-27 instrument to a newly developed administrative claim-based ACE-27 measure. STUDY DESIGN AND SETTING: Cross-sectional study of 4,300 breast and prostate cancer patients from the Centers for Disease Control and Prevent…
Impact of Non-HIV Related Comorbidities on Retention in HIV Medical Care
The Relationship Between Perceived Burden of Chronic Conditions and Colorectal Cancer Screening Among Appalachian Residents
PURPOSE: As the population living with several concurrent chronic conditions or multiple morbidity (MM) increases, understanding how to effectively fit prevention efforts into disease management becomes more important, particularly among rural, underserved populations. Compared to their urban counterparts, rural residents suffer higher rates of disease, receive fewer preventive services, and often live in environments limiting access to optimal m…
Clinical, Sociodemographic, and Service Provider Determinants of Guideline Concordant Colorectal Cancer Care for Appalachian Residents
BACKGROUND: Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer. METHODS: Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Car…
Treatment Patterns for Prostate Cancer
BACKGROUND: As evidence-based guidelines increasingly define standards of care, the accurate reporting of patterns of treatment becomes critical to determine if appropriate care has been provided. We explore the level of agreement between claims and record abstraction for treatment regimens for prostate cancer. METHODS: Medicare claims data were linked to medical records abstraction using data from the Centers for Disease Control and Prevention's…
Disparities in Colorectal Cancer Treatment Delay Within Appalachia—The Role of For‐Profit Hospitals
BACKGROUND: Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined. OBJECTIVE: This study identified the source of this disparity in treatment del…
Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants
BACKGROUND: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-…
Medicine (15 works) · Internal Medicine (10 works) · Cancer (8 works) · Global Cancer Incidence and Screening (7 works) · Healthcare Policy and Management (6 works) · Internal Medicine (6 works) · Comorbidity (5 works) · Oncology (5 works) · Breast cancer (4 works) · Chronic Disease Management Strategies (4 works)