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

解决癌症的城乡差异：扩大登记范围的案例

• 批准号: 10404646
• 负责人: Cathy J Bradley
• 金额: $ 35.49万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-14 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10404646
• 关键词: Address; Adult; American; American Indians; Area; Caring; Censuses; Cervical; Colorado; Colorectal; Communities; County; Data; Data Set; Data Sources; Databases; Dissemination and Implementation; Enrollment; Ethnic Origin; Fee-for-Service Plans; Foundations; Gender; Geographic Locations; Geography; Health Care Reform; Health Insurance; Health Personnel; Health Services; Health Services Accessibility; Healthcare; Hispanic; Hispanic Americans; Incidence; Infrastructure; Insurance; Insurance Carriers; Insurance Coverage; Investments; Lead; Link; Lung; Malignant Neoplasms; Measures; Medicaid; Medicare; Medicare/Medicaid; National Cancer Institute; Native Americans; Oral; Outcome; Patients; Persons; Pharmaceutical Preparations; Policies; Policy Analysis; Policy Maker; Population; Population-Based Registry; Prevention; Privatization; Prostate; Public Policy; Race; Registries; Research; Residencies; Resources; Risk Factors; Rural; Rural Population; SEER Program; Screening for cancer; Source; System; Testing; Time; Treatment outcome; Tumor Markers; Uninsured; adverse outcome; base; cancer care; cancer health disparity; cancer therapy; care coordination; case finding; collaborative care; data registry; disparity reduction; ethnic minority; experience; geographic disparity; health care delivery; health care disparity; implementation efforts; improved; improved outcome; innovation; malignant breast neoplasm; medical specialties; melanoma; mortality; neoplasm registry; population based; racial and ethnic; rural Hispanic; rural area; rural disparities; rural dwellers; rural residence; sex; treatment guidelines; urban area; urban disparity

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.

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的情况正在恶化。癌症结果也不例外。改善的进展 由于缺乏有关可改善成果的可采取行动的项目的数据，差异受到了阻碍。我们 提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连接起来 （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有关人员、治疗、县和地区的信息 2009-2018 年的政策和医疗保健提供水平。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、黑色素瘤和肺癌。我们的目标是： 目标 1：评估关联的 CCR 和 APCD 在农村/城市居住方面的完整性， 种族/民族、年龄、性别和保险类型（医疗保险、医疗补助、私人、无保险）。这一目标对于 在其他国家的传播和实施工作。它有两个目的：1) 通知注册机构 APCD 在病例确定和治疗数据中的效用，2) 向研究界通报 使用链接的注册表-APCD 数据的优点和缺点。 目标 2. 衡量农村居住地与以下结果之间的关系：阶段、待遇 （治疗时间、指南一致护理、新批准药物的使用）、支出和死亡率。 H1：农村居住与不良结果正相关。 H2：居住在农村地区的西班牙裔和美洲印第安人将不成比例地经历不良结果 相对于农村地区的白人同行和城市地区的西班牙裔同行。 目标 3：评估医疗补助责任医疗协作 (ACC) 对癌症结果的影响。 H1：加入 ACC 通过加强护理协调和改善农村居民的癌症结局 预防。 拟议的研究将产生新的数据，以了解中央癌症之间是否存在联系 登记处和所有付款人索赔数据库提供了宝贵的数据，有助于理解和解决差异， 特别是在农村人口中。我们测试关于医疗保健资源的距离和 可用资源的类型（初级和专业护理）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保健投资类型的政策辩论提供信息 农村和城市地区癌症治疗与死亡率之间的关系。

项目成果

Cancer Treatment Data in Central Cancer Registries: When Are Supplemental Data Needed?

• DOI: 10.1177/11769351221112457
• 发表时间: 2022
• 期刊: Cancer informatics
• 影响因子: 2
• 作者: Bradley CJ;Liang R;Jasem J;Lindrooth RC;Sabik LM;Perraillon MC
• 通讯作者: Perraillon MC