For-Profit Ownership and End-of-Life Care

描述（由申请人提供）：临终关怀是对癌症患者及其家属护理的一个日益重要的方面；目前，超过一半的癌症患者选择临终关怀。在过去的十年里，临终关怀行业经历了以营利为目的的急剧增长。营利性临终关怀医院的数量增长了300%，而非营利性临终关怀医院的数量仅增长了43%。尽管这种扩张，但我们对营利性所有权如何影响癌症患者及其家属的临终关怀知之甚少。为了解决这方面的知识差距，我们将提供关键证据，证明营利性临终关怀所有权对癌症护理的影响。我们的具体目标是：1)确定临终关怀所有权类型与基于理赔的癌症患者质量指标之间的关联，并根据患者和县级特征进行调整；2)确定无法用理赔数据评估的临终关怀所有权类型与癌症患者附加质量指标之间的关联，并检验这些关联如何被其他组织层面特征修改。为了实现这些具体目标中的第一个，我们创建了一个独特的数据集，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商数据和区域资源文件联系起来，包括88293名癌症患者的详细临床和利用数据。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，以评估由兰德公司、国家质量论坛和医学研究所推荐的基于组织的质量指标。以营利为目的的临终关怀越来越多，这一现象非常引人注目，而且对癌症患者及其家属具有潜在的深远影响。在政府和雇主寻求私营部门解决医疗保健问题的时候，问一问营利性临终关怀医院所有权对临终关怀有什么影响，并确定改善癌症护理的机会，是有意义的。外行语言的相关性：我们将产生营利性临终关怀所有权对癌症患者及其家属经历的影响的知识。

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.