{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:40:46Z","timestamp":1792370446907,"version":"4.4.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"UMGCCC American Cancer Society Institutional Research","award":["IRG-18-160-16"],"award-info":[{"award-number":["IRG-18-160-16"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older breast cancer survivors often need home-based functional support, yet whether Medicare\u2019s restricted home health (HH) benefit leaves frailty-related need unmet at the population level is not quantified because measurement is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using linked Surveillance, Epidemiology, and End Results-Medicare-OASIS data, we studied 347\u2009953 survivor-years during 2017-2020 from 134\u2009410 women with invasive breast cancer 2-10\u2009years post-diagnosis. We derived a claims-based predicted deficit-accumulation frailty index (DAFI), calibrated by penalized elastic-net to the observed OASIS Start-of-Care DAFI, the HH-need benchmark. Outcomes were any Medicare HH use and potential unmet need, defined as no HH use among high-need survivor-years (predicted DAFI \u2265 0.25). Logistic models estimated the marginal effects of DAFI on any Medicare HH use by frailty and dual eligibility, and disparities in potential unmet need.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The claims-based DAFI was closely calibrated to observed OASIS DAFI (area under the curve = 0.715; slope = 1.111). Any HH use rose with frailty (+1.10 percentage points [pp] per +0.01 DAFI; 95% CI = 1.05 to 1.15), most steeply among never-dual survivors (+1.21 pp; 95% CI = 1.16 to 1.26) and less steeply among always-dual survivors (+0.41 pp; 95% CI = 0.30 to 0.53). Among high-need survivor years, 59.6% had no Medicare HH use. Long-term survivors had similar DAFI to 2-5-year survivors (0.216 vs 0.215) and lower HH use, but potential unmet need did not differ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A claims-based frailty proxy reveals potential frailty-related needs that Medicare HH does not reach. Expanding Medicare HH to better cover personal care and other home- and community-based services may help address frailty-related needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag327","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:02:49Z","timestamp":1792368169000},"source":"Crossref","is-referenced-by-count":0,"title":["Claims-based frailty, dual eligibility, and potential unmet home-health needs in older breast cancer survivors"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1537-342X","authenticated-orcid":false,"given":"Xuanzi","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, University of Maryland School of Public Health , College Park, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Maryland School of Public Health , College Park, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Trinkoff","sequence":"additional","affiliation":[{"name":"Department of Family and Community Health, University of Maryland School of Nursing , Baltimore, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3387-4009","authenticated-orcid":false,"given":"Douglas","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Minnesota Medical School , Minneapolis, MN,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Schoenborn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD,","place":["United 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