The cost of illness: The impact of COVID-19 on patient financial outcomes

项目摘要/摘要 候选人：诺拉·贝克尔，医学博士，初级保健医生，健康经济学家，早期职业健康 服务研究员。她的长期职业目标是成为一名独立的医生-调查员和 疾病对妇女和弱势群体财务结果的影响问题国家专家，以便 为减少差距和保护患者免受经济损失的政策提供信息。 研究背景：疾病的经济后果--被称为“经济毒性”--是重要的患者 结果。财务毒性由客观财务负担和主观财务困境两部分组成。 但由于缺乏可用的数据，很难衡量客观的财政负担。此外，现有的 主观财务困境的衡量标准是有限的，而且是不同的。SARS-CoV-2(新冠肺炎) 大流行使得开发新的方法来估计和了解流感的严重程度变得更加重要 急性疾病后的经济毒性。 具体目标：1)确定新冠肺炎术后客观经济负担风险最高的患者亚群 感染；2)估计新冠肺炎感染对客观经济负担的因果影响 大流行期间的经济趋势，并按患者亚组描述结果的异质性；3)评估 与新冠肺炎感染相关的主观经济困难。 研究计划：在目标1和目标2中，贝克尔博士将对商业信用报告数据进行一种新的数据链接， 密歇根蓝十字蓝盾(BCBSM)保险索赔和邮政编码级别的社会决定因素 健康。在目标1中，她将使用机器学习方法来确定哪些患者患贫困的风险最高 新冠肺炎感染后的信用报告结果，在目标2中，她将使用先进的计量经济学方法 估计新冠肺炎感染对信用报告结果的影响，独立于整体经济趋势 在大流行期间，并按患者亚组描述结果的异质性。在《目标3》中，贝克尔博士将 适应、试点和管理新的新冠肺炎主观财务困境调查指标。 这些目标加在一起，将综合评估新冠肺炎感染的金融毒性。 职业发展计划：贝克尔博士将在1)机器学习方法、2)新的 发展先进的计量经济方法，3)主要的数据收集和调查方法，4)领导力 和沟通技巧，有效地传播她的工作，为政策变化提供信息。贝克尔博士的训练将 得到密切指导、高级教学课程、参与职业发展的支持 活动，以及与媒体和政策制定者的接触，分享她的研究成果。 研究目标：本研究的目标是确定新冠肺炎感染的财务影响，以及 患者在感染后面临最大的经济损害风险，以告知制定政策以减少 在财务结果上的差异，并更好地保护患者免受疾病的经济后果。

PROJECT SUMMARY/ABSTRACT Candidate: Nora Becker, MD, PhD, is a primary care physician, health economist, and early career health services researcher. Her long-term career objective is to become an independent physician-investigator and national expert on the impact of illness on financial outcomes for women and vulnerable populations in order to inform policies to reduce disparities and protect patients from financial harm. Research Context: The financial consequences of illness—termed “financial toxicity”—are important patient outcomes. Financial toxicity has two components, objective financial burden and subjective financial distress, but the lack of available data has made it difficult to measure objective financial burden. Further, the existing measures of subjective financial distress are limited and heterogeneous. The SARS-CoV-2 (COVID-19) pandemic has made it even more important to develop new ways to estimate and understand the magnitude of financial toxicity following acute illness. Specific Aims: 1) Identify patient subgroups at highest risk for objective financial burden after COVID-19 infection; 2) Estimate the causal effect of COVID-19 infection on objective financial burden independent of economic trends during the pandemic and describe heterogeneity in outcomes by patient subgroup; 3) Assess subjective financial distress related to COVID-19 infection. Research Plan: In Aims 1 and 2, Dr. Becker will perform a novel data linkage of commercial credit report data, Blue Cross Blue Shield of Michigan (BCBSM) insurance claims, and zip code-level social determinants of health. In Aim 1 she will use machine learning methods to identify which patients are at highest risk of poor credit report outcomes after COVID-19 infection, and in Aim 2 she will use advanced econometric methods to estimate the effect of COVID-19 infection on credit report outcomes, independent of overall economic trends during the pandemic, and describe heterogeneity in outcomes by patient subgroups. In Aim 3, Dr. Becker will adapt, pilot, and administer a new COVID-19-specific survey measure of subjective financial distress. Together, these aims will comprehensively estimate the financial toxicity of COVID-19 infection. Career Development Plan: Dr. Becker will develop expertise in 1) machine learning methods, 2) newly developed advanced econometric methods, 3) primary data collection and survey methods, and 4) leadership and communication skills to disseminate her work effectively to inform policy change. Dr. Becker's training will be supported by close mentorship, advanced didactic coursework, participation in career development activities, and engagement with media and policymakers to share the results of her research. Research Goals: The goal of this research is to identify the financial effects of COVID-19 infection, and which patients are most at risk of financial harm following infection, to inform the development of policies to reduce disparities in financial outcomes and better protect patients from the financial consequences of illness.