The role of patient experiences with care in older adult colorectal cancer patients with comorbid chronic conditions

患者护理经历在患有慢性疾病的老年结直肠癌患者中的作用

• 批准号: 10390140
• 负责人: Stephanie Ariana Navarro
• 金额: $ 5.13万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-02 至 2026-09-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390140
• 关键词: Adherence; Administrator; Adult; Area; California; Cancer Patient; Cancer Survivor; Cancer Survivorship; Caring; Chronic; Chronic Disease; Chronic Kidney Failure; Chronic Obstructive Pulmonary Disease; Clinical; Colorectal Cancer; Communication; Complex; Congestive Heart Failure; Data; Data Set; Diagnosis; Disease Management; Doctor of Philosophy; Education; Elderly; Epidemiology; Ethnic Origin; Ethnic group; Fee-for-Service Plans; Fellowship; Goals; Guidelines; Health Disparities Research; Health Information System; Health Personnel; Health Services; Healthcare; Healthcare Systems; Hospitalization; Individual; Inpatients; Intervention; Lead; Link; Malignant Neoplasms; Medical Fee for Service; Medicare; Mentors; Modification; National Cancer Institute; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Patient-Centered Care; Patients; Physicians; Population; Primary Health Care; Quality of Care; Race; Reporting; Research; Research Personnel; Resources; Risk; Role; SEER Program; Sampling; Stage at Diagnosis; Structure; Surveys; Survival Rate; Training; Training Programs; Universities; Vulnerable Populations; Work; anticancer research; cancer care; cancer diagnosis; cancer survival; care coordination; care costs; care outcomes; cohort; colon cancer patients; colorectal cancer risk; comorbidity; cost; data registry; ethnic difference; ethnic diversity; ethnic minority population; experience; follow-up; health care disparity; health disparity; health equity; human old age (65+); improved; improved outcome; medical schools; medically underserved; minority patient; mortality; mortality risk; multiple chronic conditions; neoplasm registry; patient population; population based; programs; racial and ethnic; racial diversity; survivorship

Project Summary Older adults living with chronic conditions and diagnosed with colorectal cancer (CRC) experience substandard cancer care, declines in care for their chronic conditions, and increased mortality relative to CRC patients with no additional chronic conditions. Given compounded disparities in care for racial/ethnic minority patients, non- white older adult CRC patients with comorbid chronic conditions experience even more disparate care and outcomes. Yet, little has been done to systematically seek to improve care and outcomes for this vulnerable patient group. One relatively simple solution may be to seek to optimize patients’ experiences with their care. Patients reporting better experiences with their care have greater adherence to care, improved outcomes, and decreased mortality amenable to healthcare. This research seeks to use Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to study the associations between patient experiences and health care, outcomes, and costs in a racially and ethnically diverse sample of older adult CRC patients with comorbid chronic conditions. Our specific aims are to determine racial/ethnic differences in: 1) associations between patient experiences with care and changes in chronic condition care use following CRC diagnosis in older adult patients; 2) effect modification of patient experiences with care in the relationships between comorbidity status and receiving guideline CRC care and CRC survivorship; and 3) associations between patient experiences with care and overall costs of care following CRC diagnosis in patients with and without comorbid chronic conditions. We hypothesize that, in a population-based and nationally representative cohort, older adult CRC patients with comorbid chronic conditions will have better outcomes when experiences with care are highly-rated, and that there will be disparities in these effects for racial/ethnic minority patients. Data for this research will come from the SEER- CAHPS linked dataset, using a sample of Medicare fee-for-service CRC patients with comorbid congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, or type 2 diabetes who responded to a CAHPS patient experience survey. The findings of this research will inform how we might optimize care for this vulnerable patient group and for the growing group of older adults with multimorbidity. Completion of this project will be aligned with a fellowship training plan with the goals of: 1) training in epidemiologic, health services, and health disparities research; 2) understanding multimorbidity in older adults and health disparities in later life; and 3) integrated longitudinal clinical training in primary care for medically underserved patients. This training will be conducted at the University of Southern California Keck School of Medicine (KSOM) with the support of skilled research and clinical mentors, ample research and clinical training resources, and involvements in structured training programs (such as the KSOM MD/PhD program; the Cancer Research, Education and Engagement Health Equity Center (CaRE2); and the KSOM Primary Care Program).

项目摘要 患有慢性病并被诊断患有结直肠癌（CRC）的老年人的生活水平低于 癌症护理，对他们的慢性疾病的护理下降，以及相对于CRC患者的死亡率增加， 没有其他慢性病。考虑到少数种族/族裔患者护理的复杂差异， 患有共病慢性疾病的白色老年CRC患者经历了更不同的护理， 结果。然而，在系统地寻求改善这一弱势群体的护理和结果方面， 患者组。一个相对简单的解决方案可能是寻求优化患者的护理体验。 报告护理体验更好的患者对护理的依从性更高，结局更好， 降低适合医疗保健的死亡率。这项研究旨在利用监测，流行病学和结束 结果（SEER）-医疗保健提供者和系统的消费者评估（CAHPS）数据，以研究 患者的经验和医疗保健，结果和成本之间的关系，在种族和民族 患有慢性疾病的老年CRC患者的不同样本。我们的具体目标是 确定以下方面的种族/民族差异：1）患者护理经历与 老年患者CRC诊断后的慢性病护理使用; 2）患者的效果调整 在共患病状态和接受指导性CRC护理之间的关系方面的护理经验， CRC生存率; 3）患者护理经历与护理总成本之间的相关性 在有和没有慢性疾病共病的患者中进行CRC诊断。我们假设， 基于人群和国家代表性队列，老年CRC患者合并慢性 条件将有更好的结果时，与照顾的经验是高度评价，将有 种族/少数民族患者的这些影响的差异。这项研究的数据将来自SEER- CAHPS关联数据集，使用了一个医疗保险按服务收费的CRC患者样本， 心力衰竭、慢性肾病、慢性阻塞性肺病或2型糖尿病， 对CAHPS患者体验调查作出了回应。这项研究的结果将告诉我们如何 优化对这一弱势患者群体和不断增长的老年多发病患者群体的护理。 该项目的完成将与研究金培训计划保持一致，其目标是： 流行病学、卫生服务和健康差异研究; 2）了解老年人的多发性硬化 以及晚年的健康差异;以及3）在初级保健中进行综合纵向临床培训， 缺医少药的病人本次培训将在南加州大学凯克学院进行， 医学（KSOM）与熟练的研究和临床导师，充分的研究和临床培训的支持 资源，并参与结构化的培训计划（如KSOM MD/PhD计划;癌症 研究，教育和参与健康公平中心（CaRE 2）;和KSOM初级保健计划）。