Centralization of Cancer Care: Implications for Access, Outcomes, and Disparities

项目摘要 近年来，癌症治疗已戏剧性地转向集中护理模式， 癌症患者在区域转诊中心选择性地接受复杂的治疗，这 往往是三级癌症中心。集中化与改善 在区域转诊中心接受治疗的患者出于各种原因，包括更好的 治疗大量病人的资源和人员。然而，更广泛的影响是 关于人口一级成果的集中化仍不得而知。特别值得关注的是 不在这些中心接受治疗，而是继续在非区域中心接受治疗的患者 转诊中心，通常治疗的病人数量较少。这些“留守”患者可能 由于获得高质量护理的机会减少，结果不佳。此外，在一定程度上，这些 患者代表传统上服务不足的患者(即，长期 经历过健康差距，如种族和少数民族、低收入个人和农村 居民)，集中癌症护理的趋势可能会无意中扩大结果的差距， 对那些留下来的病人的护理恶化。这个项目的总体目标是批判性地检查 癌症治疗集中在人口层面的影响，特别侧重于 集中化的趋势正在无意中扩大癌症的社会人口差异 结果。我们将使用混合方法和创新的数据集将癌症联系起来 两大州(纽约州和宾夕法尼亚州)11年来的登记和行政数据 句号。我们将重点关注最常见的(即膀胱、乳腺、结直肠、肺、 前列腺癌)和致命性(即脑癌、食道癌、肝癌、肺癌、胰腺癌)--这些癌症经常 需要复杂的治疗，并在区域转诊中心有更好的结果。在目标1中，我们 将确定与未在区域转诊中接受治疗相关的患者特征 中间。在目标2中，我们将研究在区域转诊中心接受护理是否会调解 作为传统上服务不足的患者(种族/少数民族、低收入者)之间的关系 (个人、农村居民)和护理质量。在目标3中，我们将确定将癌症降至最低的策略 通过与关键利益攸关方的面谈，了解中央集权背景下的差异。这项研究是 重要的是，它将为医院、提供商和政策制定者提供关于 集中化的方式可能既帮助又损害患者，导致新的战略 最大限度地减少健康差距，在多个层面上影响干预措施和政策变化。

Project Summary In recent years, cancer treatment has dramatically shifted towards a centralized model of care, whereby patients with cancer selectively receive complex treatment at regional referral centers, which tend to be tertiary cancer centers. Centralization is associated with improved outcomes for the patients who receive care at regional referral centers for a variety of reasons, including better resources and personnel who treat high volumes of patients. However, the broader impact of centralization on outcomes at the population level remains unknown. Of specific concern are the patients who do not receive care at these centers, but instead continue to receive care at non-regional referral centers, which generally treat lower volumes of patients. These “left behind” patients may suffer poor outcomes due to decreased access to high-quality care. Moreover, to the degree these patients represent traditionally underserved patients (i.e., sociodemographic groups that have long experienced health disparities such as racial and ethnic minorities, low-income individuals, and rural residents), the trend towards centralized cancer care may inadvertently widen disparities in outcomes, worsening care for those patients left behind. The overall goal of this project is to critically examine the impact of cancer treatment centralization at the population level, with a specific focus on whether the trend toward centralization is inadvertently widening sociodemographic disparities in cancer outcomes. We will use a mixed-methods approach as well as an innovative dataset linking cancer registry and administrative data in two large states (New York and Pennsylvania) over an 11-year period. We will focus on patients with the most prevalent (i.e., bladder, breast, colorectal, lung, prostate) and lethal (i.e., brain, esophageal, liver, lung, pancreatic) cancers—these cancers frequently require complex treatments and have improved outcomes at regional referral centers. In Aim 1, we will determine the patient characteristics associated with not receiving care at a regional referral center. In Aim 2, we will examine whether receipt of care at a regional referral center mediates the relationship between being a traditionally underserved patient (racial/ethnic minority, low-income individual, rural resident) and quality of care. In Aim 3, we will identify strategies to minimize cancer disparities in the context of centralization through interviews with key stakeholders. This study is important because it will provide hospitals, providers, and policymakers with actionable new data on the ways centralization may be both helping and harming patients, leading to new strategies to minimize health disparities with implications for interventions and policy changes at multiple levels.