Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care.
Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care.
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Medicare共享储蓄计划的早期影响负责任的护理组织参与前列腺癌护理。
DOI：
10.1002/cncr.31081
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发表时间：
2018-02-01
期刊：
影响因子：
6.2
通讯作者：
Hollenbeck BK
中科院分区：
文献类型：
--
作者：
Borza T;Kaufman SR;Yan P;Herrel LA;Luckenbaugh AN;Miller DC;Skolarus TA;Jacobs BL;Hollingsworth JM;Norton EC;Shahinian VB;Hollenbeck BK
负责任的护理组织（ACO）可以通过减少治疗差异（即避免在低价值环境中进行治疗）来改善前列腺癌的护理。我们进行了一项研究，以了解医疗保险共享储蓄计划ACO对前列腺癌护理的影响。使用20%的医疗保险样本，我们确定了2010-2013年新诊断的前列腺癌男性。治疗率、潜在的过度治疗（即，使用回归模型测量10年内因竞争性风险死亡的机会≥ 75%的男性的治疗）和医疗保险支付。ACO参与的影响进行了评估，使用差异中的差异分析。在实施ACO之前，ACO受益人的治疗率为71.8%（95%CI，70.2%-73.3%），非ACO受益人的治疗率为72.3%（95%CI，71.7%-73.0%，p=0.51）。实施后，ACO受益人的这一比率降至68.4%（95% CI，66.1%-70.7%，p=0.017），非ACO受益人的这一比率降至69.3%（95% CI，68.5%-70.1%，p<0.001）。ACO参与没有差异效应。潜在的过度治疗率从48.2%下降到48.2%，（95% CI，43.1%-53.3%）至40.2%（95% CI，32.4%-48.0%，p=0.087），非ACO受益人从44.3%（95% CI，42.1%-46.5%）增加至47.0%（95% CI，44.5%-49.5%，p=0.11）。这些变化导致ACO受益人的过度治疗显著相对减少17%（差异中差异10.8%，p=0.031）。ACO调整对付款的影响没有差异。2010年至2013年期间，前列腺癌的治疗和年度支付显着下降，但ACO的参与并没有影响这些趋势。在最不可能受益的男性中，共享储蓄ACO对齐与前列腺癌治疗的显着下降相关。
Accountable care organizations (ACOs) can improve prostate cancer care by decreasing treatment variation (i.e. avoidance of treatment in low value settings). We performed a study to understand the effect of Medicare Shared Savings Program ACOs on prostate cancer care. Using a 20% Medicare sample, we identified men with newly diagnosed prostate cancer from 2010–2013. Rates of treatment, potential overtreatment (i.e., treatment in men with ≥ 75% chance of 10-year mortality from competing risks) and Medicare payments were measured using regression models. The impact of ACO participation was assessed using difference-in-differences analyses. Prior to implementation of ACOs the treatment rate was 71.8% (95% CI, 70.2%-73.3%) for ACO and 72.3% (95% CI, 71.7%-73.0%, p=0.51) for non-ACO beneficiaries. Post-implementation, this rate declined to 68.4% (95% CI, 66.1%-70.7%, p=0.017) for ACO and 69.3% (95% CI, 68.5%-70.1%, p<0.001) for non-ACO beneficiaries. There was no differential effect for ACO participation. The rate of potential overtreatment decreased from 48.2% (95% CI, 43.1%-53.3%) to 40.2% (95% CI, 32.4%-48.0%, p=0.087) for ACO and increased from 44.3% (95% CI, 42.1%-46.5%) to 47.0% (95% CI, 44.5%-49.5%, p=0.11) for non-ACO beneficiaries. These changes resulted in significant relative decrease in overtreatment of 17% for ACO beneficiaries (difference-in-differences 10.8%, p=0.031). Payments were not differentially affected by ACO alignment. Treatment of prostate cancer and annual payments decreased significantly between 2010 and 2013, but ACO participation did not impact these trends. Among men least likely to benefit, Shared Savings ACO alignment was associated with a significant decline in prostate cancer treatment.
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影响因子：
39
作者：
Schwartz AL;Chernew ME;Landon BE;McWilliams JM
通讯作者：
McWilliams JM
DOI：
10.1056/nejmoa1311593
发表时间：
2014-03-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Bill-Axelson A;Holmberg L;Garmo H;Rider JR;Taari K;Busch C;Nordling S;Häggman M;Andersson SO;Spångberg A;Andrén O;Palmgren J;Steineck G;Adami HO;Johansson JE
通讯作者：
Johansson JE
影响因子：
6.2
作者：
Daskivich, Timothy J.;Lai, Julie;Saigal, Christopher
通讯作者：
Saigal, Christopher
影响因子：
3.4
作者：
Karaca-Mandic, Pinar;Norton, Edward C.;Dowd, Bryan
通讯作者：
Dowd, Bryan
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL