Automated Delineation of Cancer Service Areas

自动划定癌症服务区域

• 批准号: 9387606
• 负责人: Tracy Onega
• 金额: $ 22.06万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-14 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9387606
• 关键词: Address; American; American Society of Clinical Oncology; Area; Area Analyses; Atlases; Cancer Patient; Caring; Censuses; Clinical; Communities; Complex; Congresses; Continuity of Patient Care; Detection; Development; Diagnosis; Effectiveness; Environment; Evaluation; Expenditure; Future; General Hospitals; Geographic Information Systems; Geography; Goals; Health; Health Professional; Healthcare; Healthcare Market; Healthcare Systems; Hospital Referrals; Hospitalization; Hospitals; Inpatients; Institute of Medicine (U.S.); Malignant Neoplasms; Measurement; Measures; Medicare; Medicare claim; Methodology; Methods; Modeling; Network-based; Oncologist; Outcome; Outpatients; Patient Care; Patients; Pattern; Policy Developments; Policy Maker; Population; Population Characteristics; Quality of Care; Regional Cancer; Reporting; Resource Allocation; Resources; Services; Specificity; Structure; System; Technology; Testing; Time; Translating; Uncertainty; United States; Variant; Work; base; beneficiary; cancer care; cancer diagnosis; care delivery; clinical phenotype; comparative; design; health care delivery; health care service utilization; improved; indexing; interest; novel; palliation; patient oriented; patient population; pressure; programs; service utilization; survivorship; user-friendly

ABSTRACT For over 20 years, health care delivery in the U.S. has been informed by methodologies that create “service areas”, such as Hospital Service Areas (HSAs) of the Dartmouth Atlas Project, to evaluate how health care resources are distributed across the population and how that impacts health outcomes. Policy makers have used these units to assess regional variation in health care utilization and quality to design strategies for improving health and health care systems. Delivery of cancer care in the United States represents a unique set of patients, technologies, clinical specialization, and patient- centered perspectives, distinct from other patient populations. The Institute of Medicine and the American Society of Clinical Oncology have recently noted that there is a “crisis” in cancer care delivery, and highlighted the need for meaningful ways to assess quality. We propose to develop a novel method to generate Cancer Service Areas (CSAs) – geospatial units analogous to HSAs, but specific to cancer care – in order to create a framework for assessing regional cancer care delivery, quality, and outcomes. Based on health care utilization captured through all-payer claims and Medicare claims, we will extend and refine the Dartmouth HSA model. The derived CSAs have several key distinctions from existing service area delineations: a) focus on cancer-specific patient population/diagnoses; b) inclusion of outpatient claims, in addition to inpatient, to capture continuum of care; c) refinement of a complex network-based community detection method to account for spatial patterns of patient care while attaining geographic contiguity of the CSAs; and d) creation of an automated program in a Geographic Information Systems (GIS) environment that adapts to user-defined sets of services, diagnoses, or clinical phenotypes. Our specific aims are to: 1) Develop Cancer Service Areas (CSAs)- unique, cancer-specific geographic units of healthcare utilization to evaluate cancer care through a refined methodologic approach; 2) Evaluate the CSAs versus Dartmouth HSAs to assess their spatial specificity to the population of interest; and 3) Demonstrate the utility of CSAs as unique spatial units with respect to the cancer population. Creation of CSAs is an urgent need for policymakers (e.g. Congress), decision leaders (e.g. ASCO), health care systems, and ultimately patients who seek reliable, reportable information on quality cancer care. It is a first step towards these goals, and promises to serve broad service area methodologies at the same time.

摘要 20多年来，美国的医疗保健服务一直采用创建“服务领域”的方法，例如 达特茅斯地图集项目的医院服务区（HSAs），以评估医疗保健资源的分布情况 以及这对健康结果的影响。决策者利用这些单位评估区域 卫生保健利用率和质量的变化，以设计改善卫生和卫生保健系统的战略。递送 在美国，癌症护理代表了一系列独特的患者、技术、临床专业化和患者- 中心观点，与其他患者群体不同。医学研究所和美国医学会 临床肿瘤学最近指出，癌症护理服务存在“危机”，并强调需要 有意义的方法来评估质量。我们建议开发一种新的方法来生成癌症服务区（CSA）- 地理空间单位类似于HSA，但具体到癌症护理-为了创建一个框架， 癌症护理交付、质量和结果。基于通过所有付款人索赔获取的医疗保健利用率， 医疗保险索赔，我们将扩大和完善达特茅斯HSA模型。衍生的CSA有几个关键区别 从现有的服务区域划分：a）关注癌症特异性患者人群/诊断; B）纳入门诊 索赔，除了住院病人，以获得连续的护理; c）完善一个复杂的网络为基础的社区 在获得CSA的地理连续性的同时考虑患者护理的空间模式的检测方法;以及d） 在地理信息系统（GIS）环境中创建自动化程序， 服务、诊断或临床表型的集合。我们的具体目标是：1）发展癌症服务区- 独特的，癌症特定的地理单位的医疗保健利用，以评估癌症护理通过一个完善的方法 2）评估CSA与达特茅斯HSA，以评估其对目标人群的空间特异性; 和3）证明CSA作为关于癌症群体的独特空间单元的效用。创建CSA是 迫切需要政策制定者（如国会），决策领导者（如ASCO），医疗保健系统，最终 寻求可靠、可报告的优质癌症护理信息的患者。这是实现这些目标的第一步， 承诺同时提供广泛的服务领域方法。