For-Profit Ownership and End-of-Life Care

临终关怀是癌症患者及其家属护理的一个越来越重要的方面;目前，超过一半的癌症死亡患者使用临终关怀。在过去的十年中，临终关怀行业经历了急剧增长，在营利性所有权。营利性收容所的数量增长了300%，而非营利性收容所的数量只增长了43%。尽管这种扩张，我们对营利性所有权如何影响癌症患者及其家人的临终关怀知之甚少。为了解决这一知识差距，我们将提供有关营利性临终关怀所有权对癌症护理影响的关键证据。我们的具体目标是：1）确定临终关怀所有权类型与癌症死亡患者基于索赔的质量指标之间的关联，针对患者和县级特征进行调整，以及2）确定临终关怀所有权类型与无法使用索赔数据评估的癌症死亡患者的其他质量指标之间的关联，并检查这些关联如何被其他组织级特征修改。对于这些具体目标中的第一个，我们创建了一个独特的数据集，该数据集将监测，流行病学和最终结果-医疗保险数据库与医疗保险服务提供者数据和区域资源文件相关联，并包括88，293名癌症患者的详细临床和使用数据。对于第二个具体目标，我们将开发、预测试和实地调查500个临终关怀组织，以评估兰德公司、国家质量论坛和医学研究所推荐的基于组织的质量指标。越来越多的营利性临终关怀所有权的现象是戏剧性的，当前的，并有潜在的深远影响癌症患者及其家属。在政府和雇主正在寻找私营部门解决医疗保健问题的时候，询问营利性临终关怀所有权对临终关怀的影响以及确定改善癌症护理的机会是有意义的。通俗语言的相关性：我们将产生有关营利性临终关怀所有权对癌症患者及其家属的经验的影响的知识。

DESCRIPTION (provided by applicant): Hospice is an increasingly important aspect of care for patients with cancer and their families; currently, more than half of all patients dying from cancer use hospice. In the last decade, the hospice industry has experienced dramatic growth, in for-profit ownership. The number of for-profit hospices grew 300% while the number of nonprofit hospices grew only 43%. Despite this expansion, we know little about how for-profit ownership affects end-of-life care for patients with cancer and their families. To address this gap in knowledge, we will produce critical evidence about the impact of for-profit hospice ownership on cancer care. Our specific aims are: 1) to determine the association between hospice ownership type and claims-based quality indicators for patients dying from cancer, adjusted for patient and county-level features, and 2) to determine the association between hospice ownership type and additional quality indicators for patients dying from cancer that cannot be assessed with claims data and examine how these associations are modified by other organization-level features. For the first of these specific aims, we have created a unique dataset that has linked the Surveillance, Epidemiology, and End Results-Medicare database with the Medicare Provider of Services data and the Area Resource File and includes detailed clinical and utilization data for 88,293 patients with cancer. For the second specific aim, we will develop, pretest, and field a survey of 500 hospice organizations to evaluate organization-based quality indicators that have been recommended by RAND, the National Quality Forum, and the Institute of Medicine. The phenomenon of increasing for-profit ownership of hospice is dramatic, current, and has potentially far-reaching implications for patients with cancer and their families. At a time when government and employers are looking for private sector solutions to health care problems, it makes sense to ask what impact for-profit hospice ownership has on end-of-life care and to identify opportunities for improving cancer care. Relevance in lay language: We will generate knowledge about the influence of for-profit hospice ownership on the experiences of patients with cancer and their families.