MULTILEVEL COMPLIANCE MODEL OF BREAST CANCER TREATMENTS

提供者对治疗指南的遵守传统上是 被描述为一个主要与 医生。经常引用的模型来研究或干预 医生的治疗模式是以个体为基础的，并侧重于 与学习或同伴有关的各种社会心理机制-- 压力。然而，影响遵从性的因素 推荐的治疗指南实际上构成了一个复杂的网络 以心理、人际、组织和社区为基础 变量。 年早期(I或II)乳腺癌治疗指南 自1985年以来，老年妇女一直得到明确和始终如一的表述。在……里面 简要地说，推荐的主要治疗方法是保乳手术 (BCS)加放射治疗(RT)，或改良根治术。 尽管如此，BCS的使用在地域和医院方面的差异，以及 很高比例的妇女，特别是老年妇女，在没有接受BCS的情况下接受BCS 放射治疗在文献中已有报道。上一首 对这些治疗指南的遵从性研究可能已经 受制于难以确定放射治疗是否 在BCS之后收到，这是由于提供商位置的多样性 提供RT和这些数据所在的不同Medicare索赔文件 可能会被找到。 我们建议将一些现有的数据文件与宏观层面联系起来 背景数据(创建了与NCI社区临床相关联的索引 肿瘤学项目(CCOP)、NCI综合癌症中心(CCC)和 放射治疗研究网络；AHA数据；区域资源档案和人口普查 数据)到来自SEER的患有早期癌症的老年女性样本- 与医疗保险相关的数据库，以开发全国样本 这些患者有关于他们的治疗和社区的信息 设置。 我们的主要兴趣是测试联动的影响 初级治疗地点(手术和/或RT)到研究网络， 控制患者特征、其他组织变量、 以及社区环境对治疗依从性的影响。我们提出了一个 分层多分类回归模型估计3个因素的影响 接受治疗时的协变量水平。 这项研究将促进我们对以下背景的理解 遵守治疗指南的情况发生。特别是，这项研究 将提供有关上下文交互的重要信息 (组织和社区)和老龄化的临床决策 患有乳腺癌的妇女-这是一个很少在 合规性文献。

Provider compliance with treatment guidelines has traditionally been depicted as an issue primarily concerning the clinical behavior of physicians. The models often invoked to study or intervene in the treatment patterns of physicians are individual-based, and focus on various social-psychological mechanisms related to learning or peer- pressure. However, the factors which influence compliance with recommended treatment guidelines in fact constitute a complex web of psychological, interpersonal, organizational, and community-based variables. The guidelines for treatment of early stage (I or II) breast cancer in older women have been clearly and consistently stated since 1985. In brief, recommended primary treatment has been breast conserving surgery (BCS) plus radiation therapy (RT), or modified radical mastectomy. Nonetheless, geographic and hospital variation in the use of BCS, and a high portion of women, particularly older women, receiving BCS without radiation therapy have been reported in the literature. Previous studies of compliance with these treatment guidelines may have been hampered by the difficulty of determining whether radiation therapy was received following BCS, due to the variety of provider locations which provide RT and the different Medicare claims files in which these data could be found. We propose to link a number of extant data files with macro-level contextual data (created indices on linkage to NCI Community Clinical Oncology Programs (CCOP), NCI Comprehensive Cancer Centers (CCC) and radiotherapy research networks; AHA data; Area Resource File and Census data) to a sample of older women with early stage cancer from the SEER- Medicare linked data bases, in order to develop a national sample of such patients with information on their treatments and community settings. Our major interest is to test for the influence of linkage of the primary treatment sites (surgery and/or RT) to research networks, controlling for patient characteristics, other organizational variables, and community context, on treatment compliance. We propose a hierarchical polytomous regression model to estimate the effects of 3 levels of covariates on treatment received. This research will advance our understanding of the context in which compliance with treatment guidelines occurs. In particular, this study will provide important information on the interaction of context (organization and community) and clinical decision-making for aging women with breast cancer- a population that is seldom studied in the compliance literature.