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Policy implementation research on health benefit mandates for fertility preservation services to improve access to care in young cancer survivors

关于保留生育服务的健康福利要求的政策实施研究，以改善年轻癌症幸存者获得护理的机会

基本信息

批准号：
10673827
负责人：
Sara Blythe McMenamin
金额：
$ 18.1万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
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：
2022-08-01 至 2024-07-31
项目状态：
已结题

项目摘要

Nearly 90,000 adolescents and young adults ages 15 to 39 are diagnosed with cancer each year in the U.S. (AYA survivors). Fertility preservation care before cancer treatment (i.e., infertility risk counseling and fertility preservation services such as oocyte and sperm freezing) is an evidence-based practice that effectively decreases infertility after cancer, a devastating outcome. In response to cost barriers that contribute to low utilization and financial burden and distress, 11 states recently passed benefit mandate laws requiring health insurance plans to include fertility preservation benefits, with additional state and federal legislation pending. These health policies may have substantial impact on preventing infertility and mitigating medical financial hardship, but clinic and patient stakeholders report that mandated benefits are not reaching cancer patients. In implementation science, there is a knowledge gap about how contextual factors in and across the multiple levels that are engaged in implementing a health policy can inform the design of deliberate implementation strategies. Thus, the objective is to conduct a theory-informed investigation of health insurance benefit mandate implementation, in order to derive strategies to increase fertility preservation care. Guided by the EPIS framework, this developmental proposal focuses on the exploration phase via a contextual assessment of multiple levels (insurance regulators, insurers, clinics and AYA survivors) (Aim 1) and the preparation phase through co- developing with stakeholders implementation strategies for benefit mandate required fertility preservation care (Aim 2). In Aim 1, we will examine determinants of implementation, service and patient outcomes in the outer and inner contexts, as well as bridging factors between them. We will conduct surveys, document reviews, interviews and focus groups, and data will be analyzed by rapid assessment to inform subsequent data collection. In Aim 2, we will specify implementation strategies for benefit mandates and refine them with stakeholders through surveys, interviews, and focus groups. We will generate a toolkit of refined implementation strategies to evaluate in a future trial. Through a policy scan of all passed state benefit mandates, we selected California, Illinois, and New York as generalizable states because they represent key variations in environments for fertility preservation benefit mandates. The transdisciplinary team has existing, productive collaborations and complementary expertise in fertility preservation care, health policy, qualitative research and implementation science. This proposal is responsive to the Childhood Cancer STAR Act of 2018, timely in assessing new fertility preservation benefit mandates, innovative in applying implementation science methods to health policy processes and outcomes and expanding the empirical evidence on policy implementation strategies, and of potential high clinical impact through generation of novel strategies to increase access to fertility preservation and decrease adverse clinical outcomes and financial hardship in AYA survivors. Beyond fertility preservation, study results will also have implications for the ~2,000 current benefit mandates implemented across the U.S.

在美国，每年有近 90,000 名 15 至 39 岁的青少年和年轻人被诊断患有癌症。（AYA 幸存者）。癌症治疗前的生育力保存护理（即不孕风险咨询和生育力咨询）保存服务（例如卵母细胞和精子冷冻）是一种基于证据的实践，可以有效地减少癌症后的不孕症，这是一种毁灭性的结果。为了应对导致低水平的成本障碍利用率和财务负担和困扰，11 个州最近通过了福利授权法，要求健康保险计划包括保留生育能力的福利，更多的州和联邦立法正在等待中。这些卫生政策可能对预防不孕症和减轻医疗财务负担产生重大影响困难，但诊所和患者利益相关者报告说，癌症患者并未享受到强制福利。在实施科学中，对于上下文如何影响多个级别以及跨多个级别存在知识差距参与实施卫生政策的信息可以为有针对性的实施战略的设计提供信息。因此，目标是对健康保险福利授权进行基于理论的调查实施，以便制定增加生育力保存护理的策略。在EPIS框架的指导下，该发展提案侧重于通过多层次的背景评估进行探索阶段（保险监管机构、保险公司、诊所和 AYA 幸存者）（目标 1）以及通过共同参与的准备阶段与利益相关者一起制定福利任务实施战略，要求保留生育力护理（目标 2）。在目标 1 中，我们将研究外部环境中实施、服务和患者结果的决定因素。和内部背景，以及它们之间的桥梁因素。我们将进行调查、文件审查、访谈和焦点小组，数据将通过快速评估进行分析，为后续数据收集提供信息。在目标 2 中，我们将指定福利任务的实施策略，并与利益相关者一起完善它们通过调查、访谈和焦点小组。我们将生成一个包含完善实施策略的工具包，以在未来的试验中进行评估。通过对所有已通过的州福利指令的政策扫描，我们选择了加利福尼亚州，伊利诺伊州和纽约州是可概括的州，因为它们代表了生育环境的主要变化保存福利指令。跨学科团队拥有现有的、富有成效的合作，生育力保存护理、卫生政策、定性研究和实施方面的补充专业知识科学。该提案响应 2018 年《儿童癌症 STAR 法案》，及时评估新的生育能力保护福利任务，创新地将实施科学方法应用于卫生政策过程和结果，并扩大政策实施战略的经验证据，以及通过制定新策略来增加保留生育能力的机会，具有潜在的巨大临床影响减少 AYA 幸存者的不良临床结果和经济困难。除了保留生育能力之外，研究结果还将对美国目前实施的约 2,000 项福利指令产生影响