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Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery

农村医院支付和服务改革对癌症手术地域差异的影响

基本信息

批准号：
10401862
负责人：
Lindsay Marie Sabik
金额：
$ 59.3万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10401862
关键词：
Accounting Address Affect Age Area Budgets Cancer Patient Caring Characteristics Communities Complex Data Face Financial Hardship Focus Groups Goals Health Health Personnel Health Services Accessibility Healthcare Heterogeneity Hospital Administrators Hospital Restructuring Hospitals Improve Access Incentives Incidence Interview Light Link Location Malignant Neoplasms Methods Modeling National Cancer Institute Operative Surgical Procedures Outcome Patient-Focused Outcomes Patients Pattern Pennsylvania Phase Policies Population Process Provider Qualitative Evaluations Qualitative Methods Quality of Care Records Regional Cancer Resources Risk Rural Rural Community Rural Health Rural Hospitals Services Site Visit Stream Surgeon Surgical Oncology Time United States United States Centers for Medicare and Medicaid Services Variant barrier to care base cancer care cancer health disparity cancer surgery care delivery care outcomes data registry design econometrics experience experimental study financial incentive geographic disparity health care availability health care delivery hospital readmission implementation process implementation science improved improved outcome informant innovation medical specialties mortality neoplasm registry novel strategies payment population health programs response rural area rural disparities rural healthcare rural patients rural residence surgery outcome targeted delivery tumor urban area

项目摘要

Project Summary Cancer patients in rural areas have more limited access to specialized care, are less likely to receive certain treatments, and have poorer outcomes than their counterparts in non-rural areas. Over recent years, many rural hospitals have closed and a high proportion of remaining rural hospitals are in financial distress and at risk for closure, exacerbating barriers to care for rural patients. At the same time, evidence that the volume of surgeries performed in a hospital is associated with improved health outcomes, including mortality, has led to efforts to regionalize surgical care. Although the advantages of regionalization are well documented, referring cancer surgeries to high-volume centers presents challenges for patients, surgeons, and hospitals in rural communities. Against this complex backdrop, the state of Pennsylvania has initiated the Pennsylvania Rural Health Model (PRHM), an innovative program designed to provide hospitals with predictable revenue streams through global budgets and encourage participating hospitals to redesign care delivery to best meet the needs of their communities. This project will assess the impact of the PRHM on access to and outcomes associated with cancer surgery. First, we will examine the impact of the PRHM on regional cancer surgery delivery patterns by examining the location and characteristics of hospitals at which cancer patients receive surgery using statewide hospital discharge data. By decoupling payment from volume, PRHM changes the incentives for providers to perform surgeries locally versus referring patients to regional centers. We hypothesize that patients in areas served by PRHM hospitals will be more likely to be referred to high-volume centers than those in other rural hospital markets. Second, we will assess the effect of the PRHM on cancer surgery access and outcomes using linked discharge and cancer registry data. The PRHM emphasizes changes in care delivery that target improvements in population health, with a focus on access to specialty care. We hypothesize that surgical cancer patients in areas served by PRHM hospitals may experience improvements in receipt of recommended cancer surgery, time to surgery, and related health outcomes, including mortality and readmissions. Third, we will use qualitative methods to understand the PA Rural Health Model implementation process, including its impacts on resource utilization, hospital capabilities, staffing, care delivery, and financial incentives for providers. We will conduct interviews with key informants and focus groups with community stakeholders. Guided by a comprehensive conceptual model derived from implementation science, we will granularly assess the mechanisms by which PRHM succeeded or failed to affect hospital processes and outcomes for surgical cancer care. As the population in areas served by targeted hospitals continues to age, cancer incidence and the demand for high-quality surgical care will increase. Lessons from this context will be highly relevant for informing alternative payment models in rural hospitals and addressing the needs of surgical cancer patients in rural communities throughout the United States.

项目总结