The Revolving Door of Cancer Care For Older Americans

描述(申请人提供)：尽管在医疗方面取得了重大进展，但癌症仍然是美国第二大死亡原因，每两名癌症患者中就有一人死于自己的疾病。重病和垂死的癌症患者往往被困在急诊护理医院和疗养院(NH)的旋转门内。我们的初步工作发现，近三分之一的被诊断为癌症的联邦医疗保险受益人在生命的最后90天内处于NH中，在生命的最后3天中有许多过渡。在这一应用中，我们建议基于合并的最小数据集和联邦医疗保险索赔文件来检查癌症护理的质量，方法是创建癌症患者的前瞻性和回溯性队列，以量化医疗保健过渡和有待开发的潜在负担过渡的衡量标准。目前的卫生保健过渡措施侧重于出院，而一个重要的关切是住院(即过渡)是否首先是适当的。使用改进的Delphi技术，结合焦点小组和专家咨询小组，我们建议开发潜在负担过重的过渡措施(特定目标I)，记录它们的变化，并检查这些拟议的前瞻性和回溯性措施(特定目标II)的个人、组织特征和卫生市场关联。虽然基于联邦医疗保险索赔的质量指标的实施成本相对较低，但一个重要的问题是，不知道所观察到的每项拟议措施的差异是否反映了知情的患者偏好。因此，作为这项申请的一部分，我们将开展初步工作，为R01拨款申请制定调查抽样战略，通过使用现有的、经过验证的调查措施对失去亲人的家庭成员进行调查，验证这些基于索赔的措施，这些调查措施检查护理协调以及癌症护理是否以患者和家庭为中心(特定目标III)。医学研究所、绩效付费(P4P)和责任护理组织的发展要求制定措施，审查医疗保险受益人的纵向经验。该项目的结果将提供基于索赔的措施，可用于评估2010年《患者保护和平价医疗法案》为创建负责的医疗组织所做的努力，这些组织旨在促进医疗的整合和协调。这些措施可能有助于了解如何最好地为晚期癌症患者构建医疗保健。

DESCRIPTION (provided by applicant): Despite important advances in medical treatment, cancer remains the second leading cause of death in the USA with one in two cancer patients dying of his/her disease. Often seriously ill and dying cancer patients are caught within the revolving door of the acute care hospital and the nursing home (NH). Our preliminary work found that nearly one in three Medicare beneficiary decedents with a diagnosis of cancer are in a NH in the last 90 days of life, with many transitions in the last 3 days of life. In this application, we propose to examine the quality of cancer care based on merged Minimum Data Set and Medicare Claims files by creating both prospective and retrospective cohorts of cancer patients to quantify health care transitions and to-be- developed measures of potentially burdensome transitions. Current measures of health care transitions focus on the discharge from the hospital when an important concern is whether that hospitalization (i.e. transition) was appropriate in the first place. Using a modified Delphi technique with focus groups and expert advisory panel, we propose to develop measures of potentially burdensome transitions (Specific Aim I), document their variation, and examine the individual, organizational characteristics, and health market association of these proposed prospective and retrospective measures (Specific Aim II). While quality indicators based on Medicare claims are relatively inexpensive to implement, an important catch is not knowing whether the observed variation in each of the proposed measures reflects informed patient preferences. Thus, as part of this application, we will undertake a preliminary work to develop a survey sampling strategy for an R01 grant application that will validate these claims based measures with surveys of bereaved family members using existing, validated survey measures that examine care coordination and whether cancer care is patient- and family-centered (Specific Aims III). The Institute of Medicine, pay for performance (P4P), and the development of accountable care organizations call for development of measures that examine the longitudinal experience of Medicare beneficiaries. The results of this project will provide claims-based measures that could be used to evaluate Patient Protection and Affordable Care Act of 2010 efforts to create accountable care organizations, which aim to foster integration and coordination of care. Such measures potentially could help inform how best to structure health care for persons with advanced cancer.