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

项目摘要 患有慢性病并被诊断为结直肠癌(CRC)的老年人体验不合格 癌症护理，对慢性病的护理下降，与结直肠癌患者相比，死亡率增加 没有其他慢性疾病。鉴于在照顾种族/少数民族患者方面存在复杂的差距，非 患有慢性疾病的白人老年结直肠癌患者经历更多不同的护理和 结果。然而，在系统地寻求改善对这一弱势群体的护理和结果方面，几乎没有采取什么行动 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。 报告了更好的护理体验的患者对护理的忠诚度更高，结果更好， 降低死亡率要归功于医疗保健。这项研究试图使用监测、流行病学和 结果(SEER)-医疗保健提供者和系统消费者评估(CAHPS)数据，以研究 患者经历与医疗保健、结果和费用之间的关联在种族和民族 患有慢性疾病的老年结直肠癌患者的多样化样本。我们的具体目标是 在以下方面确定种族/民族差异：1)患者的护理经历与变化之间的联系 老年结直肠癌确诊后慢性条件护理的应用；2)患者的效果改善 关于合并症状况与接受指南的关系的护理体会 结直肠癌存活率；以及3)患者的护理经历与总体护理成本之间的关系 患有和不伴有慢性疾病的患者诊断为结直肠癌。我们假设，在一个 以人群为基础并具有全国代表性的老年结直肠癌合并慢性结直肠癌患者 当护理经验得到高度评价时，情况会有更好的结果，而且会有 对种族/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，使用患有充血性疾病的联邦医疗保险收费服务的结直肠癌患者样本 心力衰竭、慢性肾脏疾病、慢性阻塞性肺疾病或2型糖尿病 回答了CAHPS患者体验调查。这项研究的发现将告诉我们如何 优化对这一弱势患者群体和日益增长的患有多发病的老年人群体的护理。 该项目的完成将与研究金培训计划保持一致，其目标是：1)培训 流行病学、卫生服务和健康差距研究；2)了解老年人的多发病 和晚年的健康差距；以及3)初级医疗保健的综合纵向临床培训 服务不足的病人。这项培训将在南加州大学凯克学院进行 医学(KSOM)在熟练的研究和临床导师的支持下，大量的研究和临床培训 资源和参与有组织的培训方案(如KSOM医学博士方案；癌症 研究、教育和参与健康公平中心(Care2)；以及KSOM初级保健计划)。

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).