Underutilization of Surgical Resection in Patients with Pancreatic Cancer

胰腺癌患者手术切除未得到充分利用

• 批准号: 8298892
• 负责人: Taylor Sohn Riall
• 金额: $ 12.66万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298892
• 关键词: Accounting; Adenocarcinoma; American Medical Association; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical Practice Guideline; Complex; Coupled; Data; Diagnostic; Disease; Doctor of Medicine; Doctor of Philosophy; Early Diagnosis; Endoscopic Retrograde Cholangiopancreatography; Ensure; Evaluation; Excision; Gastroenterologist; Goals; Guidelines; Health Policy; Health Services Research; Home environment; Hospitals; Incidence; K-Series Research Career Programs; Leadership; Left; Length of Stay; Link; Magnetic Resonance Cholangiopancreatography; Malignant Neoplasms; Malignant neoplasm of pancreas; Medical; Medical Oncologist; Medical Surveillance; Medicare; Mentors; Methods; Minority; Neoplasm Metastasis; Operative Surgical Procedures; Outcome; Pancreas; Pancreatic Adenocarcinoma; Patient Care; Patients; Pattern; Physicians; Policies; Positive Lymph Node; Postoperative Period; Process; Provider; Public Health Schools; Qualifying; Radiation Oncologist; Recommendation; Research; Research Personnel; Resectable; Resources; Scanning; Skilled Nursing Facilities; Specialist; Specialized Center; Staging; Surgeon; Survival Rate; System; Testing; Texas; Time; Training; Ultrasonography; United States; Universities; University of Texas M D Anderson Cancer Center; Variant; Woman; X-Ray Computed Tomography; base; experience; improved; lymph nodes; meetings; men; mortality; novel; population based; post-doctoral training; standard of care; trend; tumor

DESCRIPTION (provided by applicant): The objective of this career development award is to provide Taylor S. Riall, M.D., Ph.D. formal postdoctoral training in healthcare policy, quality improvement, and leadership. This training will be coupled with mentored research on practice patterns, the utilization of surgical resection in patients with pancreatic cancer, and regionalization of care for this complex disease. This will enable Dr. Riall to make the full transition to independent investigator and leader in the field of health services research and health policy. A highly qualified team of mentors will supervise her training and ensure that she meets her goals. Dr. Riall will have resources available at the University of Texas Medical Branch at Galveston, the University of Texas M.D. Anderson Cancer Center, and the University of Texas School of Public Health. Pancreatic adenocarcinoma is the 4th leading cause of cancer deaths in both men and women in the United States. At the current time, surgical resection or removal of the tumor remains the only hope for long-term survival and cure for patients with this aggressive cancer. While clear evidence supports the use of surgical resection in patients with locoregional pancreatic cancer, recent studies by our group and others have determined that only 27-35% of patients with potentially resectable locoregional disease undergo surgical resection. In addition, only 75% of patients with locoregional disease are evaluated by a surgeon. Dr. Riall will use the SEER-Medicare linked data and data from the American Medical Association Physician Masterfile to achieve the following specific aims: 1) To describe the evaluation process of patients with locoregional pancreatic cancer including the percentage of patients who see a specialist and the percentage of patients who receive key diagnostic and staging tests, 2) To describe the patient, tumor, surgeon, and medical system characteristics which predict the receipt of surgery in patients with locoregional pancreatic cancer for all patients evaluated by a surgeon, 3) To evaluate the extent of and trends in regionalization of care to high-volume centers (>10 pancreatic resections per year) among Medicare patients with locoregional and metastatic pancreatic cancer, and 4) To assess variability in care among Medicare providers performing pancreatic resection to determine if volume alone is an appropriate criteria for pancreatic surgery referral. This unique, systematic, population-based analysis of the variation in use of surgical resection for pancreatic cancer at the levels of the patient, tumor, provider, and medical system will enable us to determine the reasons for underutilization of surgical resection. These data can be used as a basis for developing clinical practice guidelines and health policy for patients with pancreatic cancer, thereby reducing variations in practice patterns and optimizing outcomes for patients with this aggressive disease.

描述（由申请人提供）：该职业发展奖的目标是为Taylor S. Riall，医学博士，博士提供医疗保健政策，质量改进和领导力方面的正式博士后培训。该培训将与实践模式的指导研究相结合，胰腺癌患者手术切除的应用，以及这种复杂疾病的区域化护理。这将使Riall博士能够完全过渡到卫生服务研究和卫生政策领域的独立研究者和领导者。一个高素质的导师团队将监督她的培训，确保她实现自己的目标。Riall博士将在加尔维斯顿的德克萨斯大学医学分部、德克萨斯大学md安德森癌症中心和德克萨斯大学公共卫生学院获得资源。胰腺腺癌是美国男性和女性癌症死亡的第四大原因。目前，手术切除或切除肿瘤仍然是这种侵袭性癌症患者长期生存和治愈的唯一希望。虽然有明确的证据支持对局部胰腺癌患者进行手术切除，但我们小组和其他人最近的研究表明，只有27-35%的可能可切除的局部疾病患者进行了手术切除。此外，只有75%的局部区域性疾病患者由外科医生进行评估。Riall博士将使用SEER-Medicare相关数据和来自美国医学协会医师大师档案的数据来实现以下具体目标：1)描述局部区域胰腺癌患者的评估过程，包括看专科医生的患者百分比和接受关键诊断和分期检查的患者百分比。2)描述所有由外科医生评估的患者，预测局部区域胰腺癌患者接受手术的患者，肿瘤，外科医生和医疗系统特征。3)评估局部区域性和转移性胰腺癌的医疗保险患者向大容量中心（每年10例胰腺切除术）的护理区区化程度和趋势；4)评估实施胰腺切除术的医疗保险提供者之间的护理差异，以确定单独的胰腺体积是否是胰腺手术转诊的合适标准。这种独特的、系统的、以人群为基础的分析胰腺癌手术切除在患者、肿瘤、提供者和医疗系统水平上的差异，将使我们能够确定手术切除未充分利用的原因。这些数据可作为制定胰腺癌患者临床实践指南和卫生政策的基础，从而减少实践模式的变化，优化这种侵袭性疾病患者的预后。