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

• 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
• 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

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.

项目摘要/摘要 我们先前的工作表明，ACA下的医疗补助扩张与早期检测有关并改善 非小细胞肺癌患者的生存，这是最常见的肺癌类型。但是，医疗补助 与私人保险的同行相比 这主要是由于它们在更高级阶段诊断和不足的诊断风险较高而驱动的。 利用适合阶段的癌症治疗。这表明平等的医疗保险是必不可少的，但是 不足以确保平等获得肺癌护理和结果。医疗保健访问已经 由于个人，提供商和医疗保健的因素之间的相互作用而概念化 系统，邻里和政策水平。但是，先前的研究解决了低 - 收入患者专注于个人水平因素。我们和其他团体证明了社区 癌症护理的可及性与乳腺癌或大肠癌患者的治疗有关。医疗补助 入学前与癌症诊断与早期癌症诊断有关。少得多 关于邻里环境的影响，医疗补助的入学率以及肺部的医疗补助覆盖率 医疗补助患者对肺癌护理的癌症筛查。烟草戒烟治疗是不可或缺的 肺癌治疗的重要组成部分。尚无研究检查烟草治疗及其的利用 低收入肺癌患者的决定因素，医学欠佳的人群高患病率 尼古丁依赖性。我们假设邻里环境，医疗补助政策和医院扮演关键 在医疗补助患者中的肺癌护理和生存中的作用。采用强大的多级建模方法 在提供者和社区中的聚类帐户，我们将评估社区，政策，政策的影响 以及有关肺癌的早期发现和肿瘤治疗的医院，利用烟草治疗以及 医疗补助患者的肺癌生存以及他们对肺癌种族差异的贡献 治疗和生存。为此，我们将开发用于诊断为医疗补助的注册者的集成数据集 肺癌，包括国家代表性的癌症数据，密苏里州医疗补助的索赔和入学率（也 Medicare关于双重合格参与者的索赔），密苏里州癌症注册表数据，年度医院调查， 我们将制定的邻里上下文措施。据我们所知，这将是第一个基于人群的 研究以全面评估邻里，卫生政策和医院的因素的贡献 低收入患者的肺癌护理连续性水平。结果将有助于通过 提出潜在的可修改因素，可以针对这种脆弱的癌症护理的目标 人口，从而减少肺癌差异。解决非财务障碍的癌症护理障碍 医疗补助的参与者可以最大化医疗补助扩张的大量投资的可能性 转化为低收入患者的癌症护理进入和结果的真正收益。