Detection and treatment of breast and colorectal cancer in dual eligible beneficiaries in the Medicare Sharing Savings Program

医疗保险共享储蓄计划双重合格受益人的乳腺癌和结直肠癌的检测和治疗

• 批准号: 10440500
• 负责人: Nul L Oh
• 金额: $ 5.18万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-09 至 2025-07-07
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440500
• 关键词: Address; Affect; Aftercare; Age; Appointment; Breast; Breast Cancer Detection; Breast Cancer Treatment; Cancer Detection; Caring; Categories; Chronic; Clinical; Clinical Skills; Colonoscopy; Colorectal; Colorectal Cancer; Complex; Cost Analysis; Data; Data Set; Detection; Drug Prescriptions; Early Diagnosis; Early treatment; Enrollment; Ensure; Event; Expenditure; Fee-for-Service Plans; Goals; Health; Health Expenditures; Health Personnel; Healthcare; High-Risk Cancer; Hospitalization; Incentives; Individual; Intention; Linear Models; Link; Malignant Neoplasms; Mammographic screening; Measures; Medicaid; Medicare; Medicare claim; Medicare/Medicaid; Mentorship; Methods; Modeling; Newly Diagnosed; Organizational Models; Outcome; Outpatients; Patients; Performance; Physicians; Provider; Quality of Care; Quasi-experiment; Regression Analysis; Research; Research Proposals; SEER Program; Sampling; Savings; Scientist; Screening for cancer; Services; Survival Analysis; System; Thinking; Time; Training; Treatment Cost; Visit; Vulnerable Populations; age group; aged; base; beneficiary; burden of illness; cancer care; cancer diagnosis; cancer therapy; care coordination; clinical care; colorectal cancer screening; cost; dual eligible; experience; follow-up; health care service organization; high risk; improved; malignant breast neoplasm; medical specialties; mortality; mortality risk; multiple chronic conditions; patient population; payment; programs; screening; screening guidelines; skills; social; treatment risk; tv watching

PROJECT SUMMARY/ABSTRACT Individuals dually enrolled in Medicare and Medicaid are a socially and clinically vulnerable population who account for a disproportionate amount of healthcare expenditures paid by both programs. Dual eligibles have a higher burden of disease compared to Medicare only beneficiaries, with more than 20% of individuals having multiple chronic conditions. Dually-enrolled beneficiaries also have worse cancer outcomes. They are less likely to receive recommended screening, are less likely to receive definitive treatment after a cancer diagnosis, and have a higher risk of cancer-specific mortality. The complex social and healthcare needs of dual eligibles present a challenge in effectively delivering high-quality cancer care to these patients. Accountable care organizations (ACOs) strive to provide coordinated, high-quality care to patients while containing costs for payers. As Medicare’s predominant ACO model, the Medicare Shared Savings Program (MSSP) has shown promise in improving quality of care, generating savings per beneficiary, and caring for clinically vulnerable patients. Whether the MSSP increases the quality of care across the cancer continuum for dual eligibles remains relatively unknown. The proposed research investigates how much the MSSP ACO model improves quality of cancer care for a clinically complex, vulnerable patient population. Aim 1 will estimate the effect of MSSP ACOs on breast and colorectal cancer screening in dual eligibles ages 65-75. Aim 1 will involve a quasi-experimental approach using an intention-to-treat difference-in-difference analysis with propensity score matching. Aim 2 will employ a time- to-event survival analysis that will compare the time to treatment initiation after a primary breast or colorectal cancer diagnosis for MSSP ACO-attributed dual eligibles ages 18 and older to non-ACO dual eligibles ages 18 and older. Aim 3 will assess Medicare spending on cancer treatment for dual eligibles ages 18 and older with primary breast or colorectal cancer. Analysis of costs will use generalized linear models with a log-linked, gamma distribution. Taken together, the results of these three aims will inform policymakers and providers on whether value-based care reforms deliver better quality of care for dually enrolled beneficiaries. Through this proposed research, the outlined training plan, and the guidance of a highly experienced mentorship team, the applicant will be trained in various quantitative methods using large secondary datasets, strengthen her clinical skills and thinking for providing care to a diverse patient population, and enhance her professional skills that will make her a successful independent academic physician-scientist.

项目总结/摘要 双重参加医疗保险和医疗补助的个人是社会和临床弱势群体， 占两个项目支付的医疗支出的不成比例。双杀有 与仅医疗保险受益人相比，疾病负担更高，超过20%的人患有 多种慢性疾病双重登记的受益人也有更糟糕的癌症结果。他们不太可能 接受推荐的筛查，在癌症诊断后不太可能接受明确的治疗， 有更高的癌症死亡风险。双重杀手的复杂社会和医疗保健需求 为这些患者提供高质量的癌症护理是一项挑战。 责任医疗组织（ACO）致力于为患者提供协调一致的高质量护理， 包含付款人的费用。作为Medicare的主要ACO模式，Medicare共享储蓄计划 （MSSP）在提高护理质量，为每个受益人节省费用以及照顾 临床脆弱的患者。MSSP是否提高了整个癌症连续体的护理质量， 双杀仍然相对未知。 拟议的研究调查了MSSP ACO模型在多大程度上提高了癌症护理的质量， 临床复杂的脆弱患者群体。目的1将评估MSSP ACO对乳腺的影响， 65-75岁双杀患者的结直肠癌筛查。目标1将涉及一种准实验方法， 倾向评分匹配的意向治疗差异分析。目标2将使用时间- 事件生存期分析，将比较原发性乳腺癌或结直肠癌后至治疗开始的时间 癌症诊断为MSSP ACO归因的18岁及以上的双重死亡至18岁的非ACO双重死亡 年纪也更大了目标3将评估医疗保险在18岁及以上双重死亡者癌症治疗方面的支出， 原发性乳腺癌或结直肠癌。成本分析将使用广义线性模型， 分布综合来看，这三个目标的结果将为政策制定者和供应商提供信息， 基于价值观的护理改革为双重登记的受益人提供了更好的护理质量。 通过本研究建议，概述培训计划，并指导一个经验丰富的导师 团队，申请人将接受使用大型二级数据集的各种定量方法的培训， 她的临床技能和思维，为不同的患者群体提供护理，并提高她的专业 这些技能将使她成为一名成功的独立学术医生科学家。