The Role of a Monoclonal Gammopathy of Undetermined Significance Diagnosis in Healthcare Utilization
Authors
Castañeda-Avila, Maira AFaculty Advisor
Mara M. EpsteinAcademic Program
Clinical and Population Health ResearchUMass Chan Affiliations
Quantitative Health SciencesDocument Type
Doctoral DissertationPublication Date
2021-05-13Keywords
MGUSprecursor
Multiple Myeloma
Biological Factors
Health Services Administration
Health Services Research
Hemic and Lymphatic Diseases
Immune System Diseases
Metadata
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Background Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the United States. This dissertation was designed to: (1) Describe the trajectories of serum biomarkers over time in patients with an MGUS diagnosis, (2) Determine if an MGUS diagnosis is associated with changes in healthcare service utilization, and (3) explore the patient- and provider-level drivers of healthcare utilization in patients with MGUS. Methods Data sources include health claims and electronic health records from a community-based population of patients seeking care in central Massachusetts and primary qualitative data collected from providers and patients’ interviews. The analyses included descriptive statistics, group-based trajectory modeling, conditional Poisson regression, and qualitative data analyses. Results (1) Three distinct multi-trajectory groups of creatinine and hemoglobin were identified. (2) The rates of emergency room, hospital, and outpatient visits were higher for patients with MGUS than patients without MGUS. (3) Patients have a basic understanding of MGUS; however, some patients feel anxiety, which may affect other aspects of their lives. Patients primarily see hematologists for follow-up care; other providers have less knowledge about MGUS. Conclusions Biomarker trajectories characterize specific subpopulations of patients with MGUS over time. We found that an MGUS diagnosis is associated with higher healthcare utilization, especially during the months surrounding the diagnosis date. Finally, our study suggests that some patients with MGUS may need psychosocial support services and identifies a gap in knowledge around caring for MGUS patients among primary care providers.DOI
10.13028/zfmn-7h73Permanent Link to this Item
http://hdl.handle.net/20.500.14038/31365Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/zfmn-7h73