Understanding Racial Disparities in Cancer Surgery

描述（由申请人提供）：癌症手术后结局的种族差异越来越明显。黑人患者手术死亡率增加，5年生存率较低。这个项目将追求的假设，这些差异主要反映了次优的医疗保健系统，其中黑人患者往往接受他们的照顾。在探索医院水平的护理质量差异时，我们有3个具体目标： 艾姆岛探讨癌症手术护理结构和过程中的种族差异-使用国家医疗保险数据库（2000-4）和链接的SEER-医疗保险文件（1995-2004），我们计划研究结构和过程的护理变量可能与肺癌，乳腺癌和结直肠癌患者的种族和手术质量。 Aim II.为了确定哪些因素有助于解释手术结果中的种族差异-使用分层模型，我们将评估手术结果中的种族差异在多大程度上是由特定结构因素和护理过程的差异所解释的（来自目标1）。 Aim III.为了更深入地研究临床数据的结构和过程-为了增加我们研究的临床“粒度”，我们将使用密歇根州外科质量合作组织的前瞻性临床数据重复目标1和2，该组织涉及密歇根州17家最大的医院（包括少数民族人口占主导地位的几家医院）。 该项目将作为指导几位外科医生科学家的平台，这些科学家对膀胱、乳腺、结直肠和其他癌症的护理质量问题和种族差异感兴趣。通过指导研究机会和卫生服务研究的进一步指导，这些初级研究人员将获得必要的技能，以制定以临床为导向的研究议程，探索其领域的护理质量问题。他们还将获得必要的见解，以制定和评估旨在减少种族差异的干预措施。

DESCRIPTION (provided by applicant): Racial disparities in outcomes after cancer surgery are becoming increasingly apparent. Black patients have both increased risks of operative mortality and lower 5-year survival rates. This project will pursue the Hypothesis that these disparities primarily reflect the suboptimal health care systems in which black patients tend to receive their care. In exploring hospital-level differences in quality of care, we have 3 specific aims: Aim I. To explore racial disparities in the structure and process of care with cancer surgery - Using both national Medicare database (2000-4) and linked SEER-Medicare files (1995-2004), we plan to study structure and process of care variables potentially related to both race and surgical quality in patients with lung, breast, and colorectal cancer. Aim II. To identify which factors help explain racial disparities in surgical outcomes - Using hierarchical models, we will assess the extent to which racial disparities in surgical outcomes are explained by differences in specific structural factors and processes of care (from Aim 1). Aim III. To delve deeper into structure and process with clinical data - To add clinical "granularity" to our research, we will repeat Aims 1 and 2 using prospective clinical data from the Michigan Surgical Quality Collaborative, which involves 17 of the largest hospitals in Michigan (including several with predominantly minority populations). This project will serve as a platform for mentoring several surgeon scientists interested in quality of care issues and racial disparities in bladder, breast, colorectal, and other cancers. With mentored research opportunities and further instruction in health services research, these junior investigators will acquire the skills necessary to develop clinically-oriented research agendas exploring quality of care problems in their fields. They will also acquire insights necessary to develop and evaluate interventions aimed at reducing racial disparities.