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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护护理（即，不孕风险咨询和生育保存服务，如卵母细胞和精子冷冻）是一种基于证据的做法，减少癌症后的不孕症，这是一个毁灭性的结果。为了应对导致低成本的成本障碍，利用和财政负担和痛苦，11个州最近通过了福利授权法，要求健康保险计划将生育保护福利包括在内，其他州和联邦立法正在审议中。这些卫生政策可能对预防不孕症和减轻医疗财政负担产生重大影响困难，但诊所和病人利益相关者报告说，强制性的福利没有达到癌症患者。在实施科学，有一个知识差距，如何上下文因素在和跨多个层次参与执行卫生政策的机构可以为精心设计的执行战略提供信息。因此，本研究的目的是对健康保险福利授权进行一个理论上的调查执行，以制定战略，增加生育力保存护理。在EPIS框架的指导下，该发展建议通过多层次的背景评估，侧重于勘探阶段（保险监管机构、保险公司、诊所和AYA幸存者）（目标1）和准备阶段，与利益攸关方一起制定实施战略，以实现福利任务所需的生育力保持护理 (Aim 2）。在目标1中，我们将检查外部实施，服务和患者结果的决定因素和内在语境，以及它们之间的桥梁因素。我们将进行调查，文件审查，将通过快速评估对数据进行分析，为随后的数据收集提供信息。在目标2中，我们将详细说明效益任务的实施战略，并与利益相关者一起完善这些战略通过调查访谈和焦点小组我们将制定一套完善的执行战略，在未来的审判中进行评估。通过对所有通过的州福利授权的政策扫描，我们选择了加州，伊利诺斯州和纽约州是可推广的州，因为它们代表了生育环境的关键变化保护利益的任务。跨学科团队拥有现有的、富有成效的合作，在生育力保持护理、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是对2018年儿童癌症星星法案的回应，及时评估了新的生育能力保护福利任务，创新性地将科学方法应用于卫生政策扩大政策执行战略的经验证据，通过制定新的策略来增加生育力保存的可及性，具有潜在的高临床影响并减少不良临床结果和AYA幸存者的经济困难。除了保持生育能力，研究结果还将对美国目前实施的约2,000项福利授权产生影响。