Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries.
Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries.
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DOI：
10.1136/bmjopen-2021-049009
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发表时间：
2021-10-19
期刊：
影响因子：
2.9
通讯作者：
Dharmarajan K
中科院分区：
文献类型：
--
作者：
Marshall D;Aldridge MD;Dharmarajan K
医疗保险和医疗补助服务中心新颁布的放射肿瘤学模型（“RO模型”）旨在通过鼓励高价值护理和更有效的护理提供，测试17种癌症诊断的放射治疗的前瞻性基于事件的支付的成本节约潜力。对于骨转移，证据支持使用更高价值、更短疗程的放疗（≤10分）。我们的目标是确定骨转移的短期放射疗程（≤10个分数）的患病率，以及与这些疗程相关的设置、治疗和患者特征及其费用。使用RO模型事件文件，我们评估了2015-2017日历年期间医疗保险按服务收费受益人的治疗设置接受≤10部分骨转移放疗和支出。使用未调整和调整的回归模型，我们确定了≤10分数和支出的预测因子。根据治疗和患者特征调整的多变量模型。期间发生骨转移48810例。≤10分的大多数发作发生在医院-门诊环境中（62.8% (N=22 715)）。在调整治疗和患者因素后，医院-门诊治疗环境仍然是接受≤10分数的显著预测因子（调整OR 2.03 (95% CI 1.95, 2.12; p<0.001) vs独立治疗）。调整后对总支出贡献最大的因素是≤10个分数的分数数(- 3424美元（95% CI US$ - 3412至- 3435美元）vs - 1010；p<0.001)和治疗类型(包括调强放疗与常规外束相比的7716美元（95% CI为7424美元至8018美元）；p < 0.001)。在以发作为基础的模式下，提供高价值骨转移放疗存在可测量的性能差距，这与增加的支出有关。RO模型可能成功地提高骨转移放射治疗的价值。提高独立中心实施以姑息治疗为重点的服务的能力，可能会提高这些做法在RO模式下取得成功的能力。
The Centers for Medicare & Medicaid Services’ newly enacted Radiation Oncology Model (‘RO Model’) was designed to test the cost-saving potential of prospective episode-based payments for radiation treatment for 17 cancer diagnoses by encouraging high-value care and more efficient care delivery. For bone metastases, evidence supports the use of higher-value, shorter courses of radiation (≤10 fractions). Our goal was to determine the prevalence of short radiation courses (≤10 fractions) for bone metastases and the setting, treatment and patient characteristics associated with such courses and their expenditures. Using the RO Model episode file, we evaluated receipt of ≤10 fractions of radiotherapy for bone metastases and expenditures by treatment setting for Medicare fee-for-service beneficiaries during calendar years 2015–2017. Using unadjusted and adjusted regression models, we determined predictors of receipt of ≤10 fractions and expenditures. Multivariable models adjusted for treatment and patient characteristics. There were 48 810 episodes for bone metastases during the period. A majority of episodes for ≤10 fractions occurred in hospital-outpatient settings (62.8% (N=22 715)). After adjusting for treatment and patient factors, hospital-outpatient treatment setting remained a significant predictor of receiving ≤10 fractions (adjusted OR 2.03 (95% CI 1.95, 2.12; p<0.001) vs free-standing). The greatest adjusted contributors to total expenditures were number of fractions (US$−3424 (95% CI US$−3412 to US$−3435) for ≤10 fractions vs >10; p<0.001) and treatment type (including US$7716 (95% CI US$7424 to US$8018) for intensity modulated radiation therapy vs conventional external beam; p<0.001). A measurable performance gap exists for delivery of higher-value bone metastases radiotherapy under an episode-based model, associated with increased expenditures. The RO Model may succeed in improving the value of bone metastases radiation. Increasing the capacity of free-standing centres to implement palliative-focused services may improve the ability of these practices to succeed under the RO Model.
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影响因子：
10.3
作者：
Hartsell, WF;Scott, CB;DeSilvio, M
通讯作者：
DeSilvio, M
影响因子：
45.3
作者：
Palma, David A.;Olson, Robert;Senan, Suresh
通讯作者：
Senan, Suresh
影响因子：
2.8
作者：
Robinson, Timothy J.;Dinan, Michaela A.;Reed, Shelby D.
通讯作者：
Reed, Shelby D.
影响因子：
--
作者：
Logan, Jennifer K.;Jiang, Jing;Smith, Benjamin D.
通讯作者：
Smith, Benjamin D.
DOI：
10.1016/j.ijrobp.2018.02.037
发表时间：
2018-06-01
影响因子：
7
作者：
Spratt, Daniel E.;Mancini, Brandon R.;Jolly, Shruti
通讯作者：
Jolly, Shruti