A statewide controlled trial intervention to reduce use of unproven or ineffective breast cancer care.
A statewide controlled trial intervention to reduce use of unproven or ineffective breast cancer care.
复制标题
全州范围内的对照试验干预措施，旨在减少未经证实或无效的乳腺癌护理的使用。
DOI：
10.1016/j.cct.2016.08.005
复制
发表时间：
2016
影响因子：
2.2
通讯作者：
Nattinger,AnnB
中科院分区：
文献类型：
--
作者：
Pezzin,LilianaE;Laud,Purushottam;Neuner,Joan;Yen,TinaWF;Nattinger,AnnB
背景受到公众舆论、同行和国会预算办公室的挑战，医学专业协会已开始制定昂贵手术的“前五名”清单，这些手术至少对某些通常接受治疗的患者类别没有提供有意义的益处。然而，这些清单对医生或患者行为的影响程度仍然未知。方法我们与全州卫生系统联盟合作，检查两种干预措施的有效性：(i)“基本”公共报告和(ii)“增强”干预，通过基于智能手机的应用程序增强公共报告，为提供者提供及时信息、决策工具和个性化患者教育材料，以支持减少选择明智®或目标的八种乳腺癌干预措施的使用肿瘤学会指南。我们的目标是：(1) 检验在干预州的当代乳腺癌患者队列中，相对于比较州的常规护理，基本的公开报告是否会减少对靶向乳腺癌实践的使用； (2) 检验强化干预相对于基本干预的有效性； (3) 模拟在全国范围内实施这两种干预措施所带来的成本节约。讨论结果将提供严格的证据，证明独特的全付款人、全年龄公共报告系统在影响提供者行为方面的有效性，该系统可以很容易地输出到其他州，也可能输出到大型医疗保健系统。研究结果将进一步与 ACO 环境相关，预计该环境将为无效或未经证实的护理提供经济抑制。试验注册：ClinicalTrials.gov 编号待定。
BackgroundChallenged by public opinion, peers and the Congressional Budget Office, medical specialty societies have begun to develop “Top Five” lists of expensive procedures that do not provide meaningful benefit to at least some categories of patients for whom they are commonly ordered. The extent to which these lists have influenced the behavior of physicians or patients, however, remains unknown.MethodsWe partner with a statewide consortium of health systems to examine the effectiveness of two interventions: (i) “basic” public reporting and (ii) an “enhanced” intervention, augmenting public reporting with a smart phone-based application that gives providers just-in-time information, decision-making tools, and personalized patient education materials to support reductions in the use of eight breast cancer interventions targeted by Choosing Wisely® or oncology society guidelines. Our aims are: (1) to examine whether basic public reporting reduces use of targeted breast cancer practices among a contemporary cohort of patients with incident breast cancer in the intervention state relative to usual care in comparison states; (2) to examine the effectiveness of the enhanced intervention relative to the basic intervention; and (3) to simulate cost savings forthcoming from nationwide implementation of both interventions.DiscussionThe results will provide rigorous evidence regarding the effectiveness of a unique all-payer, all-age public reporting system for influencing provider behavior that may be easily exportable to other states, and potentially also to large healthcare systems. Findings will be further relevant to the ACO environment, which is expected to provide financial disincentives for ineffective or unproven care.Trial Registration:ClinicalTrials.gov number pending.