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

了解行业关系对癌症护理质量、结果和成本的重要性

• 批准号: 10672326
• 负责人: Aaron P Mitchell
• 金额: $ 38.47万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672326
• 关键词: Address; Adverse event; Affect; Cancer Patient; Caring; Cessation of life; Clinical Oncology; Clinical Practice Guideline; Communities; Community Physician; Data; Decision Making; Drug Industry; Drug toxicity; Etiology; Event; Fee-for-Service Plans; Future; Goals; Guidelines; Health; Health system; Healthcare Systems; Hospitalization; Industry; Internist; Intervention; Investigation; Link; Malignant Neoplasms; Manufacturer; Medical; Medical Oncologist; Medicare; Methods; Oncologist; Oncology; Outcome; Outcome Measure; Patient Selection; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Policies; Policy Maker; Prevalence; Quality of Care; Recommendation; Research; Selection for Treatments; Testing; Time; Treatment-related toxicity; acute care; cancer care; cancer therapy; cancer type; care costs; care delivery; cost; cost outcomes; end of life care; financial relationship; financial toxicity; high risk; improved; insight; interest; payment; personal narratives; therapy duration; treatment pattern

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.

项目摘要 从制药行业向美国医生的个人付款是普遍的，并且会影响医生 处方。每年约有80％的医学肿瘤学家从行业获得个人付款， 每个物理学的平均值超过5,500美元。这些支付可能导致癌症质量差异 护理分娩并可能影响患者的预后。因为选择不同的癌症治疗 直接影响患者结果，例如药物毒性，财务毒性和生存，这些结果可能是 当行业付款会导致医生的治疗选择变化时受到影响。尽管担心 行业支付对医疗实践的潜在影响，没有研究调查 行业付款导致的治疗模式的变化对患者产生了影响。短 - 定期项目目标是评估行业付款与癌症护理质量之间的关联，患者 成果和成本。长期的研究目标是了解物理行业的重要性 美国医疗保健系统内的财务关系。我们的总体假设是行业付款会影响 护理交付，最终是患者的结果。为了检验这一假设，我们将链接CMS开放付款数据 向Medicare收费服务索赔。利息的暴露将是通过治疗收到付款 与每个患者的治疗决定有关的药物制造商的医师。目标1：评估 行业支付与癌症护理质量之间的关联。我们将评估是否收到 医生的行业付款与他们提供指南偏爱的可能性有关 为每个患者（1A）和建立的低价值护理（1B）的治疗。我们假设医生 收到付款的人不太可能使用准则偏爱的治疗（1A），并且更有可能使用 低价值干预措施（1B）。目标2：评估行业付款与患者之间的关联 结果和护理成本。我们将评估是否接受了接受行业的医生治疗的患者 付款在以患者为中心的结果（例如计划外的急性护理利用，生存）方面存在差异 时间和临终护理质量（2a）以及它们在医疗保险支出中是否有差异（2B）。我们 假设由收到付款的医生治疗的患者更有可能获得急性护理 利用率，较短的生存时间和质量较低的寿命护理（2A），并增加了Medicare 支出（2b）。这项研究将是第一个评估行业付款与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的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有关身体行业互动的决定， 有可能促进癌症护理质量的改善，改善患者预后和降低成本。