Disparities in access to and outcomes of cancer surgery for rural Medicare patients

项目摘要 虽然癌症诊断和治疗仍然是国家卫生的优先事项，但最近在癌症护理方面取得的进展并没有 美国人口同样受益，特别是对于以手术为主要治疗手段的癌症， 治疗的组成部分。农村地区的癌症死亡率高于城市地区，并且 在农村人口中，存在有效筛查的癌症往往更为普遍。农村患者 接受针对某些癌症的手术较少，手术结果比城市更差 患者农村医院的持续关闭可能会加剧外科差异， 限制了农村病人接受癌症手术和专科护理的机会。自2004年以来，已有400多家乡村医院 已经关闭，另有430家医院面临关闭的高风险。尽管城乡差距 可能直接由这些关闭和随后缺乏获得外科治疗，他们也可能是一个 这是普遍缺乏经济和社会机会的后果。在这项研究中，我们将探索 使用医疗保险索赔数据的癌症护理的获得，治疗和结果的差异。而 城乡结果的差异已经得到审查，农村与其他 社会人口特征（包括种族/族裔差异和收入）尚未得到审查， 以手术为主要治疗手段的癌症。我们将1）描述这种差异的交叉性， 肺癌、胰腺癌、结肠癌和直肠癌的外科护理，2）估计医院关闭对 癌症患者在获得、治疗和结果方面的差异，以及3）评估 维持农村患者获得护理的政策解决方案，包括远程医疗和医疗补助 扩张.这项拟议的工作将使我们对景观，当前的挑战， 农村外科癌症护理的潜在解决方案。这项工作将使我们能够更好地了解护理方面的差异 农村服务不足的人口，以及地理如何与种族，民族和社会经济交叉 地位加剧了获取、质量和结果方面的差异。

PROJECT SUMMARY Though cancer diagnosis and treatment remain national health priorities, recent gains in cancer care have not been deployed to the benefit of U.S. populations equally, particularly for cancers for which surgery is a primary component of treatment. Rural areas have higher rates of cancer mortality than their urban counterparts, and cancers for which effective screening exists tend to be more prevalent in rural populations. Rural patients undergo fewer cancer-directed surgeries for some cancers and have worse surgical outcomes than urban patients. Surgical disparities could be exacerbated by the continued closure of rural hospitals, potentially limiting access to cancer surgery and specialist care for rural patients. Since 2004, over 400 rural hospitals have closed their doors, and another 430 hospitals are at high risk of closure. Though rural-urban disparities may result directly from these closures and the ensuing lack of access to surgical care, they may also be a consequence of a general lack of economic and social opportunities. In this proposed research, we will explore disparities in access to, treatment for, and outcomes of cancer care using Medicare claims data. While differences in rural-urban outcomes have been examined, the intersectionality of rurality with other sociodemographic characteristics (including racial/ethnic disparities and income) has not been examined for cancers for which surgery is a primary treatment. We will 1) describe this intersectionality in disparities in surgical care for lung, pancreatic, colon, and rectal cancers, 2) estimate the impact of hospital closure on disparities in access, treatment, and outcomes for patients with cancer, and 3) assess the potential effects of policy solutions in maintaining access to care for rural patients, including telemedicine and Medicaid expansion. This proposed work will give us an overarching view into the landscape, current challenges, and potential solutions for rural surgical cancer care. This work will allow us to better understand disparities in care for rural underserved populations, and how geography intersects with race, ethnicity, and socioeconomic status to exacerbate differences in access, quality, and outcomes.