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

项目概要 癌症护理服务系统经常提供不以患者为中心、基于证据的护理， 或可供弱势和服务不足的人群使用。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/族裔的患者以及患有多种疾病的患者。 基因组检测、靶向治疗、免疫治疗和 CAR T 细胞治疗等最新进展 使肿瘤护理变得更加复杂。同时，也进行了实质性的整合和整合。 癌症护理的提供，而对于整合如何影响癌症护理和结果知之甚少。 作为卫生保健研究和质量机构卫生系统组织倡议的一部分 和性能，我们的团队创建了一个新颖的国家数据库（增强型数据库[EDB]）。教育局 结合各种政府和非政府专有资源来确定卫生系统 作为共同拥有的提供者群体，包含有关医生、医生实践、医院的微观数据， 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，利用这些变化来了解对护理服务的影响，包括质量、新疗法的传播 治疗、利用和结果。我们将研究对参加按服务收费医疗保险的患者的护理和 那些参加医疗补助的人。除了研究基于索赔的质量和利用率衡量标准之外，我们还将链接 拥有来自美国最大的基础医学中心之一的基因检测临床数据和检测结果 体细胞基因组测试的提供商。具体来说，我们将： 1. 描述自 2010 年以来肿瘤护理提供者整合和所有权方面的变化并评估 为大量弱势群体提供服务的提供商的这些趋势存在差异， 包括农村和城市贫困患者、少数种族/族裔以及患有多种疾病的个人。 2. 利用护理组织的变化来评估一体化和卫生系统的影响 对癌症患者的护理质量、结果、利用率和支出的隶属度。我们将检查 跨多个领域的质量，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. 了解综合医院内部和外部提供的癌症护理质量和价值的程度 对于不同的弱势群体，包括生活在农村和城市的贫困人口，制度是不同的 地区、少数种族/族裔以及患有多种疾病的个人。 我们的研究将为肿瘤学从业者、付款人和政策制定者提供有价值的信息 改善肿瘤护理的可及性、质量和结果。我们的结果将为相关政策和实践提供信息 肿瘤治疗、质量测量和替代支付模式设计整合的价值。

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.