Understanding the Importance of Industry Relationships for Cancer Care Quality, Outcomes, and Costs

项目总结 制药业向美国医生支付个人费用很常见，并对医生产生影响 开处方。大约80%的医学肿瘤学家每年都会收到工业界的个人付款， 每个医生的平均收入超过5500美元。这些治疗可能会导致癌症质量的不同。 提供护理，并可能影响患者的预后。因为选择不同的癌症治疗方法 直接影响患者的结果，如药物毒性、经济毒性和生存，这些结果可能是 当行业支付导致医生的治疗选择发生变化时，会受到影响。尽管有人担心 行业支付对医疗实践的潜在影响，还没有研究调查是否 行业支付导致的治疗模式的变化会给患者带来后果。简而言之- 学期项目目标是评估行业支付和癌症护理质量、患者之间的关联 结果和成本。长期的研究目标是理解医生行业的重要性 美国医疗体系内的财务关系。我们的总体假设是，行业支付会影响 提供护理服务，并最终决定患者的结果。为了检验这一假设，我们将CMS Open Payments数据 到医疗保险按服务收费的索赔。暴露的利息将由收款方处理 与每个患者的治疗决定相关的药物制造商的医生。目标1：评估 行业支付与癌症护理质量之间的关系。我们将评估是否收到 医生的行业报酬与他们提供首选指南的可能性有关 针对每个患者的治疗(1A)和既定的低价值护理形式(1B)。我们假设医生 那些收到付款的人不太可能使用指南偏好的治疗(1A)，而更有可能使用 低价值干预措施(1B)。目标2：评估行业支付与患者之间的关联 结果和护理费用。我们将评估患者是否由接受过工业治疗的医生治疗 费用在以患者为中心的结果方面存在差异，例如计划外的急性护理利用率、存活率 临终关怀的时间和质量(2A)以及它们在医疗保险支出方面是否存在差异(2B)。我们 假设接受付款的医生治疗的患者更有可能得到急性护理 利用率、更短的生存时间和更低质量的临终关怀(2A)，并增加了医疗保险 支出(2B)。这项研究将首次评估行业支付与患者之间的关系- 有重点的结果，大大增加了我们对这些付款对卫生系统影响的了解。 这些结果可以为未来关于医生-行业互动的政策和实践决策提供信息， 潜在地有助于提高癌症护理质量、改善患者结局和降低成本。

PROJECT SUMMARY Personal payments from the pharmaceutical industry to US physicians are common and influence physician prescribing. Approximately 80% of medical oncologists receive personal payments from industry each year, with a mean of over $5,500 per physician. These payments may result in differences in the quality of cancer care delivery and potentially affect patient outcomes. Because the selection of different cancer treatments directly impacts patient outcomes such as drug toxicity, financial toxicity, and survival, these outcomes may be affected when industry payments cause changes in physicians’ treatment selection. Despite concerns about the potential influence of industry payments on medical practice, no study has investigated whether the changes in treatment patterns resulting from industry payments have consequences for patients. The short- term project goal is to evaluate the association between industry payments and cancer care quality, patient outcomes, and costs. The long-term research goal is to understand the importance of physician-industry financial relationships within the US healthcare system. Our overall hypothesis is that industry payments affect care delivery and, ultimately, patient outcomes. To test this hypothesis, we will link CMS Open Payments data to Medicare fee-for-service claims. The exposure of interest will be receipt of payments by the treating physician from a manufacturer of a drug relevant to each patient’s treatment decision. Aim 1: Assess the association between industry payments and cancer care quality. We will assess whether receipt of industry payments by physicians is associated with the likelihood that they deliver the guideline-preferred treatment for each patient (1A) and established forms of low-value care (1B). We hypothesize that physicians who received payments are less likely to use guideline-preferred treatments (1A) and are more likely to use low-value interventions (1B). Aim 2: Assess the association between industry payments and patient outcomes and costs of care. We will assess whether patients treated by physicians who received industry payments have differences in patient-focused outcomes such as unplanned acute care utilization, survival time, and quality of end-of-life care (2A) and whether they have differences in Medicare spending (2B). We hypothesize that patients treated by physicians who received payments are more likely to have acute care utilization, shorter survival time, and lower quality end-of-life care (2A) and to have increased Medicare spending (2B). This study will be the first to assess the relationship between industry payments and patient- focused outcomes, substantially increasing our understanding of the health system impact of these payments. These results may inform future policy and practice decisions regarding physician-industry interactions, potentially contributing to improvements in cancer care quality, improved patient outcomes, and lower costs.