Impact of urologist practice organization and health policy on prostate cancer treatment, overtreatment and spending

项目摘要和相关性 许多被诊断患有前列腺癌的男性即使没有任何干预也不会死于前列腺癌， 增加了过度治疗的可能性。泌尿科医生如何组织自己是强烈的 与局限性前列腺癌治疗的性质和程度有关。那些练习在 大型泌尿科团体，特别是拥有放射设施所有权的泌尿科医生， 通常治疗不太可能受益的患有前列腺癌的男性（即，过度治疗）。 相反，多专业组的泌尿科医生以较低的成本提供护理， 妥协的质量。 围绕着不断演变的卫生政策的影响的不确定性正在促使 医生们是如何调整自己的面对日益增加的管理负担， 改革，泌尿科医生单独或在小团体中执业， 实体，包括多专业组和大型泌尿科组。因为实践背景是 与前列腺癌过度治疗和支出密切相关，政策导致的调整， 泌尿科医生有重大的公共卫生影响。这项全国性研究的目标是 了解政策对泌尿科医师执业组织之间关系的影响， 前列腺癌护理（即，待遇、质量和付款）。这项赠款，其中使用国家 医疗保险数据，有以下三个目的：1）确定改变做法的效果 组织对前列腺癌的护理; 2）衡量泌尿外科医院所有权的影响 前列腺癌治疗的实践;以及，3）确定政策如何影响关系 泌尿科医师执业组织和前列腺癌护理之间的关系。我们计划使用中断 控制基线病例组合差异的时间序列和差异中的差异方法 时间趋势。 这项研究的结果对患者具有现实意义，他们自然对 以最低的成本获得最好的前列腺癌治疗。我们的发现将立即 向决策者通报政策影响在多大程度上由实践调节 组织，特别是那些历史上喜欢数量超过价值的组织。

Project Summary and Relevance Many men diagnosed with prostate cancer will not die of it even without any intervention, enhancing the possibility of overtreatment. How urologists organize themselves is strongly linked to the nature and extent of treatment for localized prostate cancer. Those practicing in large urology groups, particularly urologists with an ownership stake in radiation facilities, more commonly treat men with prostate cancer who are unlikely to benefit (i.e., overtreatment). Conversely, urologists in multispecialty groups provide care at a lower cost, without compromising quality. Uncertainty surrounding the implications of evolving health policy is prompting a sea change in how physicians align themselves. Faced with increasing administrative burden to navigate reforms, urologists practicing alone or in small groups are aligning themselves with larger entities, including multispecialty groups and large urology groups. Because practice context is strongly tied to prostate cancer overtreatment and spending, policy induced realignment of urologists has significant public health implications. The goal of this national study is to understand the effects of policy on relationships between urologist practice organization and prostate cancer care (i.e., treatment, quality and payment). This grant, which uses national Medicare data, has the following three aims: 1) To determine the effect of changing practice organization on prostate cancer care; 2) To measure the effect of hospital ownership of urology practices on prostate cancer care; and, 3) To determine how policy impacts relationships between urologist practice organization and prostate cancer care. We plan to use interrupted time series and difference-in-difference methods to control for differences in baseline case-mix and temporal trends. Results from this study have real-world implications for patients, who are naturally interested in getting the best prostate cancer care at the lowest possible cost. Our findings will immediately inform policymakers on the extent to which the impact of policy is mediated by practice organization, particularly by those that have historically favored volume over value.