Understanding optimal delivery systems for cancer care

了解癌症治疗的最佳输送系统

• 批准号: 8843812
• 负责人: David C Miller
• 金额: $ 37.79万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8843812
• 关键词: Accountability; Acute; Adherence; Advocate; Age-Years; Behavior; Cancer Hospital; Caring; Clinical; Clinical Services; Complex; Data; Diagnosis; Diagnostic; Disease; Evaluation; Expenditure; Foundations; Guidelines; Health; Health system; Healthcare; Hospital Societies; Hospitalization; Hospitals; Integrated Delivery Systems; Intervention; Link; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Measures; Medical Surveillance; Medicare; Medicare claim; Methods; Modeling; Oncologist; Operative Surgical Procedures; Outcome; Patient Care; Patients; Phase; Physicians; Policies; Primary Care Physician; Provider; Recommendation; Research; Savings; Specialist; Specific qualifier value; System; Systemic Therapy; Systems Integration; Time; United States; United States Centers for Medicare and Medicaid Services; Work; base; cancer care; cancer diagnosis; cancer therapy; cancer type; care delivery; cohort; comparative; cost; end of life; evidence base; financial incentive; improved; long term hospitalization; malignant breast neoplasm; medical specialties; mortality; oncology; patient population; payment; survivorship

DESCRIPTION (provided by applicant): The quality and cost of cancer care vary widely across hospitals and health systems. A large body of research indicates that hospitals with better outcomes tend to have large case volumes and a defined focus on cancer care. These and other data have prompted many to advocate for specialized cancer hospitals-so-called "focused factories"-as the best delivery system for achieving more efficient cancer care. However, reforms in the Affordable Care Act, including Accountable Care Organizations (ACO), are moving care away from this model. Although proponents argue that ACOs will improve efficiency by encouraging previously unaligned hospitals and physicians to evolve toward integrated delivery systems, others worry that the intended benefits will not accrue for patients with complex cancer diagnoses, and that ACOs will discourage referrals to hospitals with the greatest cancer expertise. To explore this issue, we propose a study that evaluates comprehensively the relationship between care delivery models and the quality, outcomes, and cost of cancer care in the United States. In the first aim, we will examine the impact of care delivery models on the quality of cancer care. Using national Medicare claims and linked SEER-Medicare data, we will identify cohorts of patients with breast, lung, prostate, and pancreatic cancer. We will then compare the quality of cancer care provided in different care delivery models based on levels of adherence with guideline recommendations and/or nationally-endorsed quality measures. We posit that cancer-focused hospitals will often have higher levels of adherence, due in part to their greater concentration of disease-specific expertise. In the second aim, we will assess the association between care delivery models and outcomes, including operative mortality, complications, hospitalizations, and long-term survival. We hypothesize that patients treated in cancer-focused hospitals will have better mortality outcomes, while greater delivery system integration will correlate with fewer hospitalizations following initial cancer therapy. In the third aim, we will examine cancer-related expenditures for these patient cohorts as they vary over time after diagnosis. We will also assess payments related to different clinical services including surgical procedures, systemic therapy, end-of-life care, and non-cancer-related treatments. We expect that cancer-focused hospitals will achieve savings around episodes of surgical care, and that patients treated in more integrated delivery systems will have lower longitudinal costs for their cancer care. Results from this study will prove invaluable to CMS policymakers and other stakeholders as they debate whether delivery system reforms deemed good for healthcare in general are also good for patients with cancer.

描述（由申请人提供）：不同医院和卫生系统的癌症护理质量和成本差异很大。大量研究表明，治疗效果较好的医院往往拥有大量病例，并且明确重点关注癌症护理。这些数据和其他数据促使许多人提倡专门的癌症医院（即所谓的“重点工厂”）作为实现更有效的癌症护理的最佳交付系统。然而，《平价医疗法案》中的改革，包括责任医疗组织 (ACO)，正在使医疗服务远离这种模式。尽管支持者认为，ACO 将通过鼓励以前不一致的医院和医生向综合交付系统发展来提高效率，但其他人担心，对于患有复杂癌症诊断的患者来说，预期的好处不会产生，而且 ACO 会阻止转诊到拥有最优秀癌症专业知识的医院。为了探讨这个问题，我们提出了一项研究，全面评估美国护理服务模式与癌症护理质量、结果和成本之间的关系。第一个目标是，我们将研究护理服务模式对癌症护理质量的影响。利用国家医疗保险索赔和关联的 SEER-医疗保险数据，我们将确定乳腺癌、肺癌、前列腺癌和胰腺癌患者的队列。然后，我们将根据指南建议和/或国家认可的质量措施的遵守程度，比较不同护理服务模式中提供的癌症护理质量。我们认为，以癌症为重点的医院通常会有更高的依从性，部分原因是它们更集中于特定疾病的专业知识。在第二个目标中，我们将评估护理服务模式与结果之间的关联，包括手术死亡率、并发症、住院治疗和长期生存。我们假设，在以癌症为重点的医院接受治疗的患者将有更好的死亡率结果，而更好的输送系统整合将与初始癌症治疗后更少的住院治疗相关。在第三个目标中，我们将审查与癌症相关的支出： 这些患者群体在诊断后随着时间的推移而变化。我们还将评估与不同临床服务相关的付款，包括外科手术、全身治疗、临终治疗 护理和非癌症相关治疗。我们预计，以癌症为重点的医院将在手术护理方面实现节省，并且在更综合的输送系统中接受治疗的患者的癌症护理纵向成本将更低。这项研究的结果对于 CMS 政策制定者和其他利益相关者来说将具有无价的价值，因为他们正在争论被认为有利于医疗保健的交付系统改革是否也有利于癌症患者。