Addressing Urban Rural Disparities in Cancer: The Case for Registry Expansion

美国各县之间的地理差异相当大。农村和农村之间的医疗保健差距 尤其是美国城市居民，情况正在恶化。癌症结果也不例外。朝着改善的方向发展 由于缺乏导致改善结果的可操作项目的数据，差距一直受到阻碍。我们 建议将科罗拉多州中央癌症登记处(CCR)与全州所有付款人索赔数据库联系起来 (APCD)。我们用区域资源文件和其他公共使用数据来补充这些数据，以增强 现有的基础设施。生成的数据集将包含人员、治疗、县和 2009-2018年的政策和保健提供水平。我们专注于常见的成人癌症：乳腺癌， 宫颈癌、前列腺癌、结直肠癌、黑色素瘤和肺部。我们的目标是： 目标1：根据城乡居民的居住情况，评估将CCR和APCD联系起来的完整性， 种族/民族、年龄、性别和保险类型(联邦医疗保险、医疗补助、私人、未参保)。这一目标对于 在其他州的传播和执行工作。它有两个目的：1)通知登记处 APCD在病例确定和治疗数据方面的效用，以及2)向研究界通报 使用关联的登记处--APCD数据的利弊。 目的2.测量农村居民与以下结果的关系：分期、治疗 (治疗时间、指南一致性护理、新批准药物的使用)、费用和死亡率。 H1：农村居住地将与不良后果正相关。 H2：居住在农村地区的西班牙裔和美国印第安人将不成比例地经历糟糕的结果 相对于农村地区的白人和城市地区的西班牙裔。 目标3：评估医疗补助的责任护理协作(ACC)对癌症结局的影响。 H1：ACC的登记通过加强护理协调和改善农村居民的癌症预后 预防。 这项拟议的研究将产生新的数据，以告知中心性癌症之间的联系 登记处和所有付款人索赔数据库为了解和处理差异提供了宝贵的数据， 特别是在农村人口中。我们测试了有关距离医疗保健资源的假设和 可用资源的类型(初级和专科护理)以及管理这些资源的政策。这些 评估将为有关缩小差距所需的医疗投资类型的政策辩论提供信息 农村和城市地区的癌症治疗和死亡率之间的差距。

Geographic disparities among U.S. counties are considerable. Health care disparities between rural and urban Americans, in particular, is worsening. Cancer outcomes are no exception. Progress toward ameliorating disparities has been hindered by a lack of data on the actionable items that lead to improved outcomes. We propose to link the Colorado Central Cancer Registry (CCR) with the statewide All Payer Claims Database (APCD). We supplement these data with the Area Resource File and other public use data to enhance the existing infrastructure. The resulting dataset will contain information at the person, treatment, county, and policy and health care delivery levels for the years 2009-2018. We focus on common adult cancers: breast, cervical, prostate, colorectal, melanoma, and lung. Our aims are: Aim 1: Evaluate the completeness of the linked CCR and APCD in terms of rural/urban residency, race/ethnicity, age, gender, and insurance type (Medicare, Medicaid, private, uninsured). This aim is critical for dissemination and implementation efforts in other states. It serves two purposes: 1) informs the registry about the utility of the APCD in case ascertainment and treatment data and 2) informs the research community about the benefits and pitfalls of using linked registry-APCD data. Aim 2. Measure the relationship between rural residence and the following outcomes: stage, treatment (time to treatment, guideline concordant care, use of newly approved agents), spending, and mortality. H1: Rural residence will be positively associated with adverse outcomes. H2: Hispanics and American Indians residing in rural areas will disproportionately experience poor outcomes relative to their white counterparts in rural areas and their Hispanic counterparts in urban areas. Aim 3: Evaluate the impact of Medicaid's Accountable Care Collaborative (ACC) on cancer outcomes. H1: Enrollment in ACCs improved cancer outcomes for rural residents through enhanced care coordination and prevention. The proposed study will generate new data to inform whether linkages between central cancer registries and All Payer Claims Databases yield valuable data for understanding and addressing disparities, particularly in rural populations. We test hypotheses regarding distance to health care resources and the type of resources available (primary and specialty care) and the policies that govern them. These assessments will inform policy debates about the type of health care investments needed to close the gap between cancer treatment and mortality in rural and urban areas.