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

项目摘要 从制药业到美国医生的个人付款是常见的，并影响医生 开处方大约80%的医学肿瘤学家每年从工业界获得个人报酬， 平均每位医生超过5,500美元。这些支付可能导致癌症质量的差异 护理交付，并可能影响患者的结果。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，尽管担心 行业支付对医疗实践的潜在影响，没有研究调查是否 行业付款导致的治疗模式的变化对患者产生了影响。短- 长期项目的目标是评估行业支付和癌症护理质量，患者 结果和成本。长期的研究目标是了解医生行业的重要性 美国医疗保健体系内的财务关系。我们的总体假设是，行业支付影响 医疗服务以及最终的患者结果。为了验证这一假设，我们将CMS Open Payments数据 医疗保险按服务收费索赔。利息的暴露将是治疗者收到的付款， 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 行业支付和癌症护理质量之间的关联。我们将评估是否收到 医生的行业支付与他们提供指南首选的可能性相关 为每个病人提供治疗（1A）和建立低价值护理形式（1B）。我们假设医生 接受付款的人不太可能使用指南首选的治疗（1A），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。我们将评估接受工业治疗的医生治疗的患者是否 支付在以患者为中心的结果方面存在差异，例如计划外急性护理利用率、生存率 时间和临终关怀的质量（2A）以及他们在医疗保险支出方面是否存在差异（2B）。我们 假设接受付费医生治疗的患者更有可能接受急性护理 利用率，生存时间较短，质量较低的临终关怀（2A），并增加医疗保险 支出（2B）。这项研究将是第一个评估行业支付和患者之间关系的研究。 重点成果，大大增加了我们对这些付款对卫生系统影响的理解。 这些结果可能会为未来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、改善患者结果和降低成本。

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.