Managed Care Penetration and Cancer Care

管理式医疗渗透率和癌症护理

• 批准号: 6361918
• 负责人: EDWARD GUADAGNOLI
• 金额: $ 36.65万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6361918
• 关键词: breast neoplasms; cancer rehabilitation /care; colorectal neoplasms; combination cancer therapy; health care cost /financing; health care quality; health care service utilization; human data; mammography; managed care; neoplasm /cancer diagnosis; neoplasm /cancer therapy; prostate neoplasms; prostate specific antigen

Recent evidence suggests that as the market share of managed care increases, expenditures in the fee-for-service sector decrease. This observation demonstrates managed care's extensive effect on the entire health care system and is referred to as a "spillover" effect. It is not known; however, whether quality of care in the fee-for-service sector varies as function of managed care penetration. If lower expenditures in markets with higher penetration result from reductions in the provision of needed services, quality of care in these markets will either decline or improve at a slower rate than in other markets. We propose to examine whether managed care penetration is associated with the quality of care and choice of treatments provided to Medicare patients diagnosed with breast, colorectal, or prostate cancer. We will (1) examine the association between managed care penetration and the quality of care (annual mammography following initial therapy for women diagnosed with early-stage breast cancer; adjuvant chemotherapy for patients diagnosed with stage III colon cancer; adjuvant chemotherapy and radiation therapy for patients diagnosed with stage II or III rectal cancer; recommended surveillance activities (for example, colonoscopy within one year of diagnosis) for patients diagnosed with colorectal cancer; and PSA testing within one year of diagnosis for men diagnosed with localized prostate cancer; (2) examine the association between managed care penetration and the use of treatments that are equally effective but that differ in cost for breast cancer (mastectomy versus breast conserving surgery) and prostate cancer (conservative management versus surgery or radiation therapy); and (3) examine mechanisms by which changes in managed care penetration may lead to changes in patterns of care. That is, whether the influence of managed care on the provider specialty composition within a market and on the availability of technologies within a market will partially explain variations in care associated with changes in managed care penetration. We will use SEER-Medicare data to identify patients diagnosed between 1992 and 1996. We will obtain data from the Health Care Financing Administration and from InterStudy to construct measures of managed care penetration at the county, Health Care Resource Area, and Metropolitan Statistical Area level. We will conduct our analyses within each of these levels using hierarchical regression models. Efforts to reduce cancer- related morbidity and mortality depend upon the provision of services known to be effective. In cases where one effective treatment has not been identified, quality of life can be improved by providing services that are congruent with patients' preferences. This project seeks to determine whether market forces influence the patterns of cancer care. If managed care penetration is negatively associated with the delivery of care, interventions targeted toward policy-makers, providers, and patients will be needed to counteract the effects of market forces.

最近的证据表明，随着管理式保健的市场份额增加，收费服务部门的支出减少。 这一观察结果表明，管理式医疗对整个卫生保健系统的广泛影响，被称为“溢出”效应。 目前尚不清楚，但是，是否在收费服务部门的护理质量不同的功能管理式护理渗透。 如果由于所需服务的提供减少而导致渗透率较高的市场的支出减少，则这些市场的护理质量将下降或以比其他市场更慢的速度改善。 我们建议检查管理式医疗渗透率是否与医疗质量和治疗选择相关，这些治疗提供给诊断为乳腺癌、结直肠癌或前列腺癌的医疗保险患者。 我们将（1）研究管理式医疗渗透率与医疗质量之间的关系（对诊断为早期乳腺癌的妇女进行初步治疗后每年进行乳房X光检查;对诊断为第三期结肠癌的患者进行辅助化疗;对诊断为第二或第三期直肠癌的患者进行辅助化疗和放射治疗;对于诊断为结直肠癌的患者，建议进行监测活动（例如，诊断后一年内进行结肠镜检查）;对于诊断为局限性前列腺癌的男性，建议在诊断后一年内进行PSA检测;（2）检查管理式医疗渗透率与使用同样有效但成本不同的乳腺癌治疗方法之间的关系（乳房切除术与保乳手术）和前列腺癌（保守治疗与手术或放射治疗）;及（3）探讨管理式医疗渗透率的改变可能导致医疗模式改变的机制。 也就是说，管理式医疗对市场内提供者专业组成的影响以及对市场内技术可用性的影响是否会部分解释与管理式医疗渗透率变化相关的护理变化。 我们将使用SEER医疗保险数据来识别1992年至1996年之间诊断的患者。 我们将从卫生保健融资管理局和InterStudy获得数据，以构建县、卫生保健资源区和大都市统计区层面的管理式医疗渗透率。 我们将使用分层回归模型在每个级别内进行分析。 降低癌症相关发病率和死亡率的努力取决于提供已知有效的服务。 在尚未确定一种有效治疗方法的情况下，可以通过提供符合患者偏好的服务来改善生活质量。 该项目旨在确定市场力量是否影响癌症护理模式。 如果管理式医疗渗透率与医疗服务的提供呈负相关，则需要针对政策制定者、提供者和患者的干预措施来抵消市场力量的影响。