CANCER PREVENTION FOR MINORITY WOMEN IN A MEDICAID HMO

医疗补助 HMO 中少数民族妇女的癌症预防

• 批准号: 3373061
• 负责人: ALAN L HILLMAN
• 金额: $ 23.55万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-30 至 1996-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3373061
• 关键词: Medicare /Medicaid; breast neoplasm /cancer diagnosis; cancer prevention; cervix neoplasms; colorectal neoplasms; diagnosis quality /standard; female; health care service evaluation; human data; human middle age (35-64); human subject; mammography; managed care; mass screening; neoplasm /cancer diagnosis; neoplasm /cancer education; neoplasm /cancer therapy; primary care physician; urban poverty area

This resubmission proposes a randomized controlled trial to assess the impact of a system of periodic feedback and financial incentives on physician compliance with cancer screening guidelines in HealthPASS, Philadelphia's Medicaid HMO. The study will investigate whether the provision of feedback to primary care sites every six months, when linked to a financial bonus program specifically based on the extent of cancer prevention provided, improves on primary care provider attention to prevention for women ages 50 and over. The specific study questions are: 1) does the intervention change adherence to screening guidelines for breast examination, mammography, pap smear, and fecal occult blood testing, and, if so, to what extent; 2) are these four components of cancer prevention affected differently by the intervention; 3) how quickly does the intervention impact on provider behavior; and, 4) how does the magnitude of the effect differ for different types of providers and/or patients? Approximately 100 primary care sites participating in HealthPASS will be randomly assigned to an experimental or control group. Sites in both groups will be audited once every six months for two years, using HealthPASS' auditing tools and procedures. Compliance with cancer screening guidelines will be determined using computerized scoring algorithms. Experimental group sites will receive detailed feedback on their performance every six months, and sites which perform well and/or improve significantly will receive financial bonuses. The study is significant for several reasons: it focuses on using financial incentives to improve quality of care, rather than to limit utilization and control costs; it uses a prospective, randomized design; it seeks to improve prevention for a traditionally under-served minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care for the indigent and uninsured.

这份重新提交的报告提出了一项随机对照试验，以评估 定期反馈和财政奖励制度对 医生遵守HealthPASS中的癌症筛查指南， 费城医疗保健组织 该研究将调查 每六个月向初级保健站点提供反馈，如果链接 根据癌症的严重程度， 提供预防，提高初级保健提供者对 50岁及以上妇女的预防。 具体的研究问题是： 1)干预是否改变了对筛查指南的依从性， 乳房检查、乳房X光检查、巴氏涂片和粪便潜血 测试，如果是，在多大程度上; 2）这四个组成部分是 干预对癌症预防的影响不同; 3）如何 干预是否会迅速影响供应商的行为;以及，4）如何 对于不同类型的提供者，影响的大小是否不同 和/或患者？ 约100个初级保健站点参与 HealthPASS将被随机分配到实验组或对照组。 两组的研究中心将每六个月接受一次审计，为期两年， 使用HealthPASS的审计工具和程序。 癌症依从性 筛选指南将使用计算机评分确定 算法 实验组研究中心将收到关于以下内容的详细反馈： 每六个月的业绩，以及业绩良好和/或 显着改善将获得财务奖金。 这项研究是 有几个重要原因：它侧重于利用金融 鼓励提高护理质量，而不是限制利用率 和控制成本;它使用前瞻性，随机设计;它旨在 改善对传统上得不到充分服务少数群体的预防工作; 而且，它是在一个被认为是 为穷人和无保险者提供护理的主要模式。