Effects of Provider Integration on the Quality of Post-Acute Care Delivered to Patients with Cancer

项目摘要 癌症护理提供系统经常提供不以患者为中心，以证据为基础， 或弱势群体和得不到充分服务的人群。癌症护理和结果特别差， 生活在农村地区、高度贫困地区、少数种族/民族的患者和多发性硬化症患者。 最近的进展，如基因组测试，靶向治疗，免疫治疗和CAR T细胞治疗， 使肿瘤治疗变得更加复杂。与此同时，还大力整合和巩固了 癌症护理的提供，以及对整合如何影响癌症护理和结果知之甚少。 作为卫生系统组织卫生保健研究和质量机构倡议的一部分， 和性能，我们的团队创建了一个新的国家数据库（增强型数据库[EDB]）。教育局 结合各种政府和非政府专有资源，以确定卫生系统 作为共同拥有的提供者的组，并且包含关于医生、医生实践、医院 和卫生系统。 我们建议利用EDB的纵向数据来描述癌症护理的整合 随着时间的推移，使用这些变化来了解对护理提供的影响，包括质量，新的 治疗、利用和结果。我们将研究参加按服务收费的医疗保险的病人的护理， 参加医疗补助的人除了研究基于索赔的质量和利用率测量外，我们还将 与基因检测的临床数据和测试结果从基金会医学，全国最大的之一， 体细胞基因组检测的供应商。具体而言，我们将： 1.描述自2010年以来肿瘤护理提供者的整合和所有权的变化，并评估 为大量弱势或处境不利人口提供服务的提供者在这些趋势上的差异， 包括农村和城市贫困患者、少数种族/民族和患有多发性硬化症的个人。 2.利用护理组织的变化来评估整合和卫生系统的影响 附属关系的护理质量，结果，利用率和癌症患者的支出。我们将研究 多个领域的质量，包括护理协调，指南推荐的护理，避免 低价值护理和患者体验。 3.了解癌症护理的质量和价值在整合内部与外部的程度 针对各种弱势群体，包括生活在农村和城市贫民区的个人， 地区、种族/少数民族和患有多种疾病的个人。 我们的研究将为肿瘤学从业者、支付者和政策制定者提供有价值的信息， 改善肿瘤治疗的可及性、质量和结果。我们的研究结果将为与以下方面有关的政策和做法提供信息： 整合肿瘤治疗、质量衡量和替代支付模式设计的价值。

Project Summary The cancer care delivery system frequently provides care that is not patient-centered, evidence-based, or accessible to vulnerable and underserved populations. Cancer care and outcomes are particularly poor for patients living in rural areas, areas with high poverty, racial/ethnic minorities, and patients with multimorbidity. Recent advances such as genomic testing, targeted therapy, immunotherapy, and CAR T cell therapy have made oncology care more complex. Concurrently, there has been substantial integration and consolidation of the delivery of cancer care, and little is known about how consolidation impacts cancer care and outcomes. As part of an Agency for Health Care Research and Quality initiative on Health Systems Organization and Performance, our team created a novel national database (Enhanced DataBase [EDB]). The EDB combines a wide variety of governmental and non-governmental proprietary sources to identify health systems as groups of commonly owned providers and contains microdata on physicians, physician practices, hospitals, and health systems. We propose to leverage longitudinal data from the EDB to characterize the integration of cancer care over time, using these changes to understand effects on care delivery, including quality, diffusion of new therapies, utilization, and outcomes. We will study care for patients enrolled in fee-for-service Medicare and those enrolled in Medicaid. In addition to studying claims-based measures of quality and utilization, we will link with clinical data about genetic testing and test results from Foundation Medicine, one of the country's largest providers of somatic genomic testing. Specifically, we will: 1. Describe changes in integration and ownership of oncology care providers since 2010 and assess differences in these trends for providers serving large numbers of vulnerable or disadvantaged populations, including rural and urban poor patients, racial/ethnic minorities, and individuals with multimorbidity. 2. Leverage changes in the organization of care to assess the impact of integration and health system affiliation on quality of care, outcomes, utilization, and spending for patients with cancer. We will examine quality across multiple domains, including care coordination, guideline recommended care, avoidance of low-value care, and patient experiences. 3. Understand the extent to which quality and value of cancer care delivered within vs. outside of integrated systems differs for various disadvantaged populations, including individuals living in rural and urban poor areas, racial/ethnic minorities, and individuals with multi-morbidity. Our study will provide oncology practitioners, payers, and policy makers valuable information to improve access, quality and outcomes of oncology care. Our results will inform policies and practices related to the value of integration of oncology care, quality measurement, and design of alternative payment models.