Staff View
Examining the multilevel influences on diabetes and hypertension clinical care management among breast cancer patients

Descriptive

TitleInfo
Title
Examining the multilevel influences on diabetes and hypertension clinical care management among breast cancer patients
Name (type = personal)
NamePart (type = family)
Doose
NamePart (type = given)
Michelle
DisplayForm
Michelle Doose
Role
RoleTerm (authority = RULIB)
author
Name (type = personal)
NamePart (type = family)
Bandera
NamePart (type = given)
Elisa V.
DisplayForm
Elisa V. Bandera
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
chair
Name (type = personal)
NamePart (type = family)
Tsui
NamePart (type = given)
Jennifer
DisplayForm
Jennifer Tsui
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
co-chair
Name (type = personal)
NamePart (type = family)
Demissie`
NamePart (type = given)
Kitaw
DisplayForm
Kitaw Demissie`
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
internal member
Name (type = personal)
NamePart (type = family)
Lin
NamePart (type = given)
Yong
DisplayForm
Yong Lin
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
internal member
Name (type = personal)
NamePart (type = family)
Cantor
NamePart (type = given)
Joel C.
DisplayForm
Joel C. Cantor
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
internal member
Name (type = personal)
NamePart (type = family)
Hong
NamePart (type = given)
Chi-Chen
DisplayForm
Chi-Chen Hong
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = personal)
NamePart (type = family)
Steinberg
NamePart (type = given)
Michael B.
DisplayForm
Michael B. Steinberg
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (type = corporate)
NamePart
School of Graduate Studies
Role
RoleTerm (authority = RULIB)
school
TypeOfResource
Text
Genre (authority = marcgt)
theses
OriginInfo
DateCreated (encoding = w3cdtf); (keyDate = yes); (qualifier = exact)
2019
DateOther (qualifier = exact); (type = degree)
2019-05
CopyrightDate (encoding = w3cdtf); (qualifier = exact)
2019
Language
LanguageTerm (authority = ISO 639-3:2007); (type = text)
English
Abstract
Background: Cancer, type 2 diabetes mellitus, and hypertension are important public health issues for women in the United States given their significant disease burden and impact on mortality. Yet, clinical care management of chronic health conditions before and after a breast cancer diagnosis has not been well evaluated, especially among African American women who disproportionately bear the burden of these chronic illnesses. Specific Aims: The specific aims of this dissertation were to evaluate the influence of a breast cancer diagnosis on diabetes and hypertension clinical care management (Chapter 1) and then examine patient (Chapter 1), provider (Chapter 2), and health system (Chapter 3) factors associated with clinical care management and health outcomes after the breast cancer diagnosis. Methods: This study included African American women who participated in the Women’s Circle of Health Follow-Up Study (WCHFS), an ongoing population-based prospective cohort of breast cancer survivors recruited from ten counties in New Jersey. Women with diabetes and/or hypertension for at least one year prior to the breast cancer diagnosis (2012-2016) were included in this analytic sample (N=274). The likelihood of receiving all clinical care management measures and achieving all health outcomes after breast cancer diagnosis were compared by patient, provider, and health system factors using binomial regression models. Results: The prevalence of diabetes and hypertension diagnosed at least one year prior to the breast cancer diagnosis was 18% and 47%. Less than half (41%) of the participants had all key clinical care management measures met and only 15% reached all key health outcomes after breast cancer diagnosis. Patients who did not have optimal management before diagnosis were 29% less likely to have optimal management after breast cancer diagnosis (aRR: 0.71; 95% CI: 0.53, 0.95). Participants with shared care (i.e., cancer specialist, primary care provider, and/or medical specialist involved in patient care) were five times more likely to have all clinical care measures met compared with participants who only saw cancer specialists (aRR: 5.07; 95% CI: 1.47, 17.51). Patient and provider factors were not associated with optimal health outcomes. Participants who did not receive both primary care and cancer care within the same health system were 27% less likely to have all clinical care measures met compared with those participants who sought care at the same health system (aRR: 0.73; 95% CI: 0.56, 0.97). Accreditation of cancer program was not associated with having all clinical care measures met (aRR: 0.92; 95% CI: 0.59, 1.45). Conclusion: Findings from these studies can be used to identify gaps in care delivery, improve chronic disease management guidelines for breast cancer patients with comorbidities, and address health equity for African American women with multimorbidities. Future work is needed from a multilevel perspective – health policy, health system, organizational/practice settings, providers/medical teams, and patient level factors – to improve the delivery of care and ultimately impact health outcomes.
Subject (authority = local)
Topic
Cancer care delivery
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = LCSH)
Topic
Breast -- Cancer -- Patients -- Medical care
Subject (authority = LCSH)
Topic
Non-insulin-dependent diabetes -- Patients -- Medical care
Subject (authority = LCSH)
Topic
Hypertension in women -- Medical care
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
RelatedItem (type = host)
TitleInfo
Title
School of Graduate Studies Electronic Theses and Dissertations
Identifier (type = local)
rucore10001600001
Identifier
ETD_9648
Identifier (type = doi)
doi:10.7282/t3-cvyp-h764
PhysicalDescription
Form (authority = gmd)
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
1 online resource (ix, 122 pages)
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Location
PhysicalLocation (authority = marcorg); (displayLabel = Rutgers, The State University of New Jersey)
NjNbRU
Genre (authority = ExL-Esploro)
ETD doctoral
Back to the top

Rights

RightsDeclaration (ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Doose
GivenName
Michelle
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2019-04-01 12:09:36
AssociatedEntity
Name
Michelle Doose
Role
Copyright holder
Affiliation
Rutgers University. School of Graduate Studies
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
RightsEvent
Type
Embargo
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2019-05-31
DateTime (encoding = w3cdtf); (qualifier = exact); (point = end)
2020-05-30
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after May 30th, 2020.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
Back to the top

Technical

RULTechMD (ID = TECHNICAL1)
ContentModel
ETD
OperatingSystem (VERSION = 5.1)
windows xp
CreatingApplication
Version
1.6
DateCreated (point = end); (encoding = w3cdtf); (qualifier = exact)
2019-03-30T22:17:37
DateCreated (point = end); (encoding = w3cdtf); (qualifier = exact)
2019-04-01T12:05:00
ApplicationName
macOS Version 10.14.3 (Build 18D109) Quartz PDFContext
Back to the top
Version 8.3.13
Rutgers University Libraries - Copyright ©2021