Enriching Claims-Based Analysis of Prostate Cancer Treatment Decision Making

丰富前列腺癌治疗决策的基于索赔的分析

• 批准号: 8917845
• 负责人: Bruce L. Jacobs
• 金额: $ 11.2万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8917845
• 关键词: Accountability; Address; Affect; Aftercare; Aging; Amber; Cancer Control; Caring; Data; Data Analyses; Decision Making; Development; Disease; Elderly; Elderly man; Environment; Equation; Exposure to; Fee-for-Service Plans; Foundations; Frequencies; Future; Goals; Health; Health Services Research; Health Services for the Aged; Health system; Hospitals; Intervention; Life Expectancy; Link; Malignant Neoplasms; Malignant neoplasm of prostate; Measurement; Measures; Medicare; Medicare claim; Mentors; Mentorship; Minority; Modeling; Morbidity - disease rate; National Institute on Aging; Natural History; Oncologist; Operative Surgical Procedures; Outcome; PSA screening; Patient Care; Patient observation; Patients; Pattern; Physicians; Primary Health Care; Provider; Radiation therapy; Relative (related person); Reporting; Research; Research Design; Retirement; Sampling; Societies; Specialist; Surveys; System; Work; base; beneficiary; cancer therapy; care seeking; clinically relevant; design; disorder risk; experience; financial incentive; functional status; health care delivery; health related quality of life; high risk; improved; meetings; men; older men; older patient; shared decision making; skills; urologic

DESCRIPTION (provided by applicant): Background: Prostate cancer is a common disease that predominantly affects older men. Men with low-risk disease are frequently good candidates for observation, while those with high-risk disease and otherwise favorable life expectancy are often good candidates for treatment. In both situations, excellent cancer control with low morbidity can be achieved by appropriately selecting patients for observation versus treatment. Yet the management of prostate cancer seldom meets this ideal. High rates of both over and undertreatment exist. Hypotheses posited to explain these observations include a fragmented healthcare delivery system and lack of skill in prognostication among specialists involved in prostate cancer treatment decisions. In contrast, geriatric models of care seek to integrate care across providers and settings, promote shared decision-making, and use models of functional-status informed prognostication. Medicare claims-based analyses of prostate cancer treatment patterns offer the only nationally-representative data on the causes and consequences of over and undertreatment. Critical barriers to a deeper understanding of these phenomena using claims are lack of information regarding the provider networks responsible for beneficiaries' care and lack of clinically relevant information about beneficiary functional status. Objective: The overarching goal of this proposal is to address these critical barriers by: 1) developing empiric measurements of provider accountability and care attribution; and 2) exploring the influence of functional status and health-related quality of life on treatment decision making. Specific aims: 1) To empirically derive physician-hospital networks (PHNs) within SEER-Medicare data for future characterization of prostate cancer treatment patterns and outcomes among the elderly; and 2) to explore the effect of functional status on prostate cancer treatment patterns among the elderly. Study Design: We will use SEER-Medicare to develop primary care and prostate cancer treatment anchored PHNs and then profile PHN attributes hypothesized to be relevant to rates of over and undertreatment (Aim 1). We will use SEER-Medicare Health Outcomes Survey data and incorporate generalized estimating equations to examine patient-reported, geriatric-focused measures before and after prostate cancer treatment (Aim 2). Relevance to National Institute on Aging: Findings from this proposal will address critical barriers to claims- based analyses related to provider accountability/care attribution and to the lack of information on patient- reported measures. The proposal will provide geriatric-focused mentorship and methodological experience, including exposure to PHNs and to functional status measurement. These opportunities will lay the foundation for examining provider factors associated with better treatment targeting and for evaluating the relationship between functional status and prostate cancer treatment decision making.

描述（由申请人提供）： 背景：前列腺癌是一种常见疾病，主要影响老年男性。患有低风险疾病的男性通常是观察的良好候选者，而患有高风险疾病和其他预期寿命良好的男性通常是治疗的良好候选者。在这两种情况下，通过适当选择观察患者而不是治疗患者，可以实现良好的癌症控制和低发病率。然而前列腺癌的治疗很少能达到这一理想。过度治疗和治疗不足的比例都很高。为解释这些观察结果而提出的假设包括支离破碎的医疗保健服务系统以及参与前列腺癌治疗决策的专家缺乏预测技能。相比之下，老年护理模型寻求整合跨提供者和环境的护理，促进共同决策，并使用功能状态知情预测模型。基于医疗保险索赔的前列腺癌治疗模式分析提供了有关过度治疗和治疗不足的原因和后果的唯一具有全国代表性的数据。使用索赔更深入地了解这些现象的关键障碍是缺乏有关负责受益人护理的提供者网络的信息以及缺乏有关受益人功能状态的临床相关信息。目标：本提案的总体目标是通过以下方式解决这些关键障碍：1）制定提供者责任和护理归因的经验衡量标准； 2）探索功能状态和健康相关生活质量对治疗决策的影响。具体目标： 1) 在 SEER-Medicare 数据中凭经验得出医生-医院网络 (PHN)，以用于未来描述老年人前列腺癌治疗模式和结果； 2）探讨老年人功能状态对前列腺癌治疗模式的影响。研究设计：我们将使用 SEER-Medicare 开发初级保健和前列腺癌治疗锚定的 PHN，然后分析假设与过度治疗和治疗不足率相关的 PHN 属性（目标 1）。我们将使用 SEER-Medicare 健康结果调查数据并结合广义估计方程来检查前列腺癌治疗前后患者报告的、以老年人为中心的测量结果（目标 2）。与国家老龄化研究所的相关性：该提案的调查结果将解决基于索赔的相关分析的关键障碍 提供者责任/护理归因以及缺乏患者报告措施的信息。该提案将提供以老年人为中心的指导和方法学经验，包括接触 PHN 和功能状态测量。这些机会将为检查与更好的治疗目标相关的提供者因素以及评估功能状态与前列腺癌治疗决策之间的关系奠定基础。

项目成果

The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab.

• DOI: 10.1016/j.urpr.2016.03.007
• 发表时间: 2017-01-01
• 期刊: Urology practice
• 影响因子: 0.8
• 作者: Bandari, Jathin;Turner, Robert M 2nd;Davies, Benjamin J
• 通讯作者: Davies, Benjamin J

Editorial Comment: Industry Payments to Urologists in 2014: an Analysis of the Open Payments Program.

编辑点评：2014 年泌尿科医师行业付款：开放式付款计划分析。

• DOI: 10.1016/j.urpr.2016.07.016
• 发表时间: 2017
• 期刊: Urology practice
• 影响因子: 0.8
• 作者: Bandari,Jathin;Jacobs,BruceL
• 通讯作者: Jacobs,BruceL

Urology Payments from Industry in the Sunshine Act.

• DOI: 10.1016/j.urpr.2015.12.002
• 发表时间: 2016-09
• 期刊: Urology practice
• 影响因子: 0.8
• 作者: Bandari J;Turner RM 2nd;Jacobs BL;Davies BJ
• 通讯作者: Davies BJ

Change in Functional Status After Prostate Cancer Treatment Among Medicare Advantage Beneficiaries.

医疗保险优惠受益人前列腺癌治疗后功能状态的变化。

• DOI: 10.1016/j.urology.2019.05.029
• 发表时间: 2019
• 期刊: Urology
• 影响因子: 2.1
• 作者: Jacobs,BruceL;Lopa,SamiaH;Yabes,JonathanG;Nelson,JoelB;Barnato,AmberE;Degenholtz,HowardB
• 通讯作者: Degenholtz,HowardB