Underutilization of Surgical Resection in Patients with Pancreatic Cancer

胰腺癌患者手术切除未得到充分利用

• 批准号: 7918848
• 负责人: Taylor Sohn Riall
• 金额: $ 12.66万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918848
• 关键词: Accounting; Adenocarcinoma; American Medical Association; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical Practice Guideline; Complex; Coupled; Data; Diagnostic; Disease; Doctor of Medicine; Doctor of Philosophy; Early Diagnosis; Endoscopic Retrograde Cholangiopancreatography; Ensure; Evaluation; Excision; Gastroenterologist; Goals; Guidelines; Health Policy; Health Services Research; Home environment; Hospitals; Incidence; K-Series Research Career Programs; Leadership; Left; Length of Stay; Link; Magnetic Resonance Cholangiopancreatography; Malignant Neoplasms; Malignant neoplasm of pancreas; Medical; Medical Oncologist; Medical Surveillance; Medicare; Mentors; Methods; Minority; Neoplasm Metastasis; Operative Surgical Procedures; Outcome; Pancreas; Pancreatic Adenocarcinoma; Pancreatic Diseases; Patient Care; Patients; Pattern; Physicians; Policies; Positive Lymph Node; Postoperative Period; Process; Provider; Public Health Schools; Qualifying; Radiation Oncologist; Recommendation; Research; Research Personnel; Resectable; Resources; Scanning; Skilled Nursing Facilities; Specialist; Specialized Center; Staging; Surgeon; Survival Rate; System; Testing; Texas; Time; Training; Ultrasonography; United States; Universities; University of Texas M D Anderson Cancer Center; Variant; Woman; X-Ray Computed Tomography; base; experience; improved; lymph nodes; meetings; men; mortality; novel; population based; post-doctoral training; standard of care; trend; tumor

DESCRIPTION (provided by applicant): The objective of this career development award is to provide Taylor S. Riall, M.D., Ph.D. formal postdoctoral training in healthcare policy, quality improvement, and leadership. This training will be coupled with mentored research on practice patterns, the utilization of surgical resection in patients with pancreatic cancer, and regionalization of care for this complex disease. This will enable Dr. Riall to make the full transition to independent investigator and leader in the field of health services research and health policy. A highly qualified team of mentors will supervise her training and ensure that she meets her goals. Dr. Riall will have resources available at the University of Texas Medical Branch at Galveston, the University of Texas M.D. Anderson Cancer Center, and the University of Texas School of Public Health. Pancreatic adenocarcinoma is the 4th leading cause of cancer deaths in both men and women in the United States. At the current time, surgical resection or removal of the tumor remains the only hope for long-term survival and cure for patients with this aggressive cancer. While clear evidence supports the use of surgical resection in patients with locoregional pancreatic cancer, recent studies by our group and others have determined that only 27-35% of patients with potentially resectable locoregional disease undergo surgical resection. In addition, only 75% of patients with locoregional disease are evaluated by a surgeon. Dr. Riall will use the SEER-Medicare linked data and data from the American Medical Association Physician Masterfile to achieve the following specific aims: 1) To describe the evaluation process of patients with locoregional pancreatic cancer including the percentage of patients who see a specialist and the percentage of patients who receive key diagnostic and staging tests, 2) To describe the patient, tumor, surgeon, and medical system characteristics which predict the receipt of surgery in patients with locoregional pancreatic cancer for all patients evaluated by a surgeon, 3) To evaluate the extent of and trends in regionalization of care to high-volume centers (>10 pancreatic resections per year) among Medicare patients with locoregional and metastatic pancreatic cancer, and 4) To assess variability in care among Medicare providers performing pancreatic resection to determine if volume alone is an appropriate criteria for pancreatic surgery referral. This unique, systematic, population-based analysis of the variation in use of surgical resection for pancreatic cancer at the levels of the patient, tumor, provider, and medical system will enable us to determine the reasons for underutilization of surgical resection. These data can be used as a basis for developing clinical practice guidelines and health policy for patients with pancreatic cancer, thereby reducing variations in practice patterns and optimizing outcomes for patients with this aggressive disease.

描述（由申请人提供）：这个职业发展奖的目标是提供泰勒S。Riall，医学博士，博士在医疗保健政策，质量改进和领导方面的正式博士后培训。这项培训将与指导研究实践模式，胰腺癌患者手术切除的利用，以及这种复杂疾病的护理区域化相结合。这将使Riall博士能够完全过渡到卫生服务研究和卫生政策领域的独立调查员和领导者。一个高素质的导师团队将监督她的培训，并确保她达到她的目标。Riall博士将在加尔维斯顿的得克萨斯大学医学分支、得克萨斯大学医学博士、安德森癌症中心和德克萨斯大学公共卫生学院。胰腺癌是美国男性和女性癌症死亡的第四大原因。目前，手术切除或切除肿瘤仍然是这种侵袭性癌症患者长期生存和治愈的唯一希望。虽然有明确的证据支持对局部胰腺癌患者进行手术切除，但我们小组和其他人最近的研究表明，只有27-35%的可能可切除的局部疾病患者接受手术切除。此外，只有75%的局部疾病患者由外科医生进行评估。Riall博士将使用SEER-Medicare关联数据和美国医学会医师主文件中的数据来实现以下特定目标：1）描述局部胰腺癌患者的评估过程，包括看专科医生的患者百分比和接受关键诊断和分期检查的患者百分比，2）描述患者、肿瘤、外科医生，和医疗系统特征，这些特征预测外科医生评估的所有患者的局部胰腺癌患者接受手术，3）评估大容量中心护理区域化的程度和趋势（每年>10例胰腺切除术）在患有局部和转移性胰腺癌的Medicare患者中，和4）评估医疗保险提供者之间进行胰腺切除术的护理差异，以确定单独的体积是否是胰腺手术转诊的适当标准。这种独特的，系统的，以人群为基础的分析，在胰腺癌手术切除术的患者，肿瘤，供应商和医疗系统的水平上的变化，将使我们能够确定手术切除术利用不足的原因。这些数据可以作为制定胰腺癌患者临床实践指南和健康政策的基础，从而减少实践模式的变化并优化这种侵袭性疾病患者的结局。