权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Impacts of Neighborhood Contexts and Medicaid Policy on Lung Cancer Survival in Low-SES Patients

社区背景和医疗补助政策对低 SES 患者肺癌生存的影响

基本信息

批准号：
10663376
负责人：
Min Lian
金额：
$ 34.94万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10663376
关键词：
Accounting Address Biological Models Cancer Patient Caring Collaborations Colorectal Cancer Continuity of Patient Care Counseling Data Data Set Data Sources Databases Diagnosis Disease Disparity Early Diagnosis Early treatment Enrollment Ensure Environmental Risk Factor Future Geography Guidelines Health Policy Health Services Accessibility Health behavior and outcomes Health care facility Healthcare Healthcare Systems High Prevalence Hospitals Individual Intervention Investments Link Low Income Population Low income Malignant Neoplasms Malignant neoplasm of lung Measures Mediastinal Medicaid Medicare claim Missouri Modeling Molecular Neighborhoods Nicotine Dependence Non-Small-Cell Lung Carcinoma Outcome Patients Pattern Pharmacotherapy Play Policies Population Study Primary Care Privatization Provider Recommendation Risk Role Rural SEER Program Safety Screening for cancer Smoke Smoker Smoking Specialist Staging Surveys Taxes Testing Tobacco Translating Transportation Underserved Population Vulnerable Populations Work cancer care cancer diagnosis cancer health disparity cancer survival cancer therapy care outcomes cohort data integration data registry dual eligible health care availability health equality high risk improved low socioeconomic status lung cancer screening malignant breast neoplasm medical vulnerability medically underserved population multilevel analysis multimodality neighborhood association neoplasm registry population based population health prior authorization programs public policy on tobacco racial difference racial disparity rural patients smoke-free policy socioeconomic disparity standard care survival disparity targeted treatment tobacco cessation intervention transportation access treatment program

项目摘要

PROJECT SUMMARY/ABSTRACT Our prior work showed that Medicaid expansion under the ACA is associated with early detection and improved survival in patients with non-small cell lung cancer, the most common type of lung cancer. However, Medicaid enrollees with lung cancer still have much worse survival compared with their privately insured counterparts, which is driven predominantly by their higher risks of being diagnosed at more advanced stages and under- utilizing stage-appropriate cancer treatment. This suggests that equal healthcare coverage is essential, but insufficient, to ensure equal access to lung cancer care and outcomes. Healthcare access has been conceptualized as a result of the interactions between factors across the individual, provider and healthcare system, neighborhood, and policy levels. However, prior studies addressing lung cancer disparities in low- income patients focused on individual-level factors. We and other groups demonstrated that neighborhood accessibility to cancer care is associated with treatment in patients with breast or colorectal cancer. Medicaid enrollment pre- vs. peri-cancer diagnosis is associated with early-stage cancer diagnoses. Much less is known about the influences of neighborhood contexts, Medicaid enrollment continuation, and Medicaid coverage of lung cancer screening on lung cancer care in Medicaid patients. Tobacco cessation treatment is an integral and essential part of lung cancer treatment. No study has examined the utilization of tobacco treatment and its determinants in low-income lung cancer patients, a medically underserved population with high prevalence of nicotine dependence. We hypothesize that neighborhood contexts, Medicaid policies, and hospitals play critical roles in lung cancer care and survival in Medicaid patients. Employing a robust multilevel modelling approach to account for clustering within providers and neighborhoods, we will assess the impacts of neighborhoods, policies, and hospitals on early detection and oncologic treatment for lung cancer, utilization of tobacco treatment, and lung cancer survival in Medicaid patients, as well as their contributions to racial disparities in lung cancer treatment and survival. To this end, we will develop integrated datasets for Medicaid enrollees diagnosed with lung cancer, which includes nationally representative cancer data, Missouri Medicaid claims and enrollment (also Medicare claims for dual eligible enrollees), Missouri Cancer Registry data, Annual Hospital Surveys, neighborhood contextual measures that we will develop. To our knowledge, this will be the first population-based study to comprehensively assess the contributions of factors at the neighborhood, health policy, and hospital levels to the lung cancer care continuum in low-income patients. The results will help inform interventions by suggesting potentially modifiable factors that could be targeted to improve cancer care in this vulnerable population and thereby reduce lung cancer disparities. Addressing non-financial barriers to cancer care in Medicaid enrollees could maximize the likelihood that substantial investments in Medicaid expansion will translate into true gains in cancer care access and outcomes for low-income patients.

项目总结/摘要我们先前的工作表明，ACA下的医疗补助扩张与早期发现和改善有关。非小细胞肺癌是肺癌最常见的类型。然而，Medicaid 与私人保险的同行相比，肺癌登记者的生存率仍然要差得多，这主要是因为他们在更晚期和更低的阶段被诊断出的风险更高，利用阶段适当的癌症治疗。这表明平等的医疗保险是必不可少的，但这是不充分的，以确保平等获得肺癌护理和成果。医疗保健服务已经概念化为个体、提供者和医疗保健之间因素相互作用的结果系统、邻里和政策层面。然而，以前的研究表明，肺癌的差异在低- 收入患者关注个人层面因素。我们和其他组织证明了获得癌症护理与乳腺癌或结肠直肠癌患者的治疗有关。医疗补助登记癌前与癌周诊断与早期癌症诊断相关。知之甚少关于邻里环境，医疗补助登记延续和医疗补助覆盖率的影响，癌症筛查对医疗补助患者肺癌护理的影响。戒烟治疗是一个不可或缺的，肺癌治疗的重要组成部分。没有研究调查烟草治疗的利用及其低收入肺癌患者的决定因素，这是一个医疗服务不足的人群，尼古丁依赖我们假设，邻里环境，医疗补助政策和医院发挥关键作用在肺癌护理和医疗补助患者生存中的作用。采用稳健的多层次建模方法，考虑到供应商和社区内的集群，我们将评估社区，政策，和医院对肺癌的早期发现和肿瘤治疗，烟草治疗的利用，医疗补助患者的肺癌生存率，以及他们对肺癌种族差异的贡献治疗和生存。为此，我们将为被诊断患有以下疾病的医疗补助计划注册者开发综合数据集：肺癌，其中包括全国代表性的癌症数据，密苏里州医疗补助索赔和登记（还双重合格登记者的医疗保险索赔），密苏里州癌症登记数据，年度医院调查，我们将开发的邻里关系措施。据我们所知，这将是第一个基于人口的研究综合评估邻里、卫生政策和医院因素的贡献低收入患者的肺癌护理连续性水平。研究结果将有助于为干预措施提供信息，这表明潜在的可改变的因素，可以有针对性地改善这一脆弱群体的癌症护理。从而减少肺癌发病率的差异。解决癌症护理的非财务障碍医疗补助注册者可以最大限度地提高医疗补助扩张的大量投资的可能性，转化为低收入患者获得癌症护理和成果的真正收益。