Joseph, Jennifer2021-02-222021-02-222018-12https://hdl.handle.net/11299/218707University of Minnesota Ph.D. dissertation.December 2018. Major: Health Services Research, Policy and Administration. Advisors: Beth Virnig, Nathan Shippee. 1 computer file (PDF); viii, 117 pages.Consensus and evidence-based guidelines or quality measures provide treatment recommendations to promote standardized, high-quality health care. This research focused on a specific guideline which recommends stage III colon cancer patients to receive adjuvant chemotherapy within 4 months of diagnosis. It was endorsed by the National Quality Forum (NQF) in 2007 and has yet to be investigated for two important yet understudied health care quality domains: timeliness and racial/ethnic equity of care. Data from the linked Surveillance and Epidemiology and End Results (SEER) cancer registry and Medicare claims were used to investigate the following topics: 1. disparities in guideline-concordant adjuvant chemotherapy receipt, distinguishing between omitted and delayed chemotherapy as forms of guideline discordance; 2. racial/ethnic disparities in timeliness of adjuvant chemotherapy receipt, while assessing wait time disparities before and after tumor resection; 3. the impact of the guideline in changing rates of timely adjuvant chemotherapy receipt and racial differences in trends over time. This research provides important new insights into racial/ethnic equity of cancer care for White, Black, Hispanic, and Asian/Pacific Islander patients, with a nuanced focus on timeliness and delay that is overlooked in the quality of care literature.enAdjuvant ChemotherapyColon CancerHealth EquityQuality of CareSEER-MedicareTimeliness/Delayed CareThesis or Dissertation