Multidimensional access and prostate cancer treatment disparities

项目总结(见说明)： 癌症治疗中的种族差异得到了很好的描述，但人们对此知之甚少。尽管大多数专家认为，获得护理是造成这些差距的原因之一，但弱势群体的获得是一个复杂、多层面的过程，保险覆盖面或旅行时间的衡量标准不能充分反映这一过程。在这一应用中，我们建议在我们之前对种族差异、前列腺癌治疗和获得护理的研究的基础上，调查卫生保健获得的多维图景对前列腺癌治疗中的种族差异的贡献。 我们将收集大费城地区8个县被诊断为患有局限性前列腺癌(N=3,000)的男性的人口样本以及获得前列腺癌治疗机会的泌尿科医生和放射肿瘤学家的初步数据。我们将重点关注这一领域，因为这是拟议中心的主要重点，也因为人们对城市人口癌症护理的多个方面知之甚少。在Penchansky和Thomas的准入框架的基础上，我们将使用患者调查、行政记录和提供者清单中的数据，评估前列腺癌护理的可及性/可用性、住宿条件、可负担性和可接受性。遵循Aday&Andersen的框架，我们将创建潜在访问的空间测量&经验访问的个人测量(已实现访问的一种形式)。我们将使用患者的经验数据，以及AMA主文件中有关提供商董事会认证和培训的数据，纳入有关提供商特征的信息。然后，我们将研究潜在的可获得性、有经验的可及性和待遇差异之间的关系，以及这些影响在多大程度上受到保险覆盖范围、社会经济地位和邻里剥夺的影响。据我们所知，这将是第一个通过收集患者、提供者和行政来源的信息来构建获得癌症护理的全面、多维图景的研究，并利用这幅图景来提高我们对癌症治疗中的种族差异的理解

PROJECT SUMMARY (See instructions): Racial disparities in cancer treatment are well described but poorly understood. Although most experts believe that access to care contributes to these disparities, access for vulnerable populations is a complex, multidimensional process that is inadequately captured by measures of insurance coverage or travel time. In this application, we propose to build upon our prior researching racial disparities, prostate cancer treatment and access to care to investigate the contribution of a multidimensional picture of health care access to racial differences in prostate cancer treatment. We will collect primary data on a population based sample of men diagnosed with localized prostate cancer (N=3,000) in 8 counties in the Greater Philadelphia area and on the urologists and radiation oncologists who form their access to prostate cancer treatment. We will focus on this area as it is the primary focus of the proposed center and because the multiple dimensions of cancer care in urban populations are poorly understood. Building on the access framework of Penchansky and Thomas, we will assess the accessibility /availability, accommodation, affordability, & acceptability of prostate cancer care, using data from a patient survey, administrative records, & a provider inventory. Following the framework of Aday & Andersen, we will create spatial measures of potential access & individual measures of experienced access (a form of realized access). We will incorporate information about the characteristics of providers using data from patients about their experiences, as well as data from the AMA masterfile about provider board certification and training. We will then examine the relationships between potential access, experienced access, & differences in treatment as well as the degree to which these effects are mediated by insurance coverage, socioeconomic status & neighborhood deprivation. To our knowledge, this will be the first study to construct a comprehensive, multi-dimensional picture of access to cancer care by collecting information from patients, providers & administrative sources & to use this picture to improve our understanding of a racial difference in cancer treatment