Cancer Care Delivery in Medicaid

医疗补助中的癌症护理服务

• 批准号: 7849028
• 负责人: Deborah Schrag
• 金额: $ 40.89万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-31 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7849028
• 关键词: 21 year old; Accounting; Address; Adjuvant; Adjuvant Chemotherapy; Adult; Affect; Age; American; Benchmarking; Breast; Caliber; California; Cancer Burden; Cancer Intervention; Cancer Patient; Caring; Cervix Uteri; Colon; Communities; Comorbidity; Complex; Data; Data Linkages; Diagnosis; Diagnostic Neoplasm Staging; Disease; Economically Deprived Population; Effectiveness; Elderly; Eligibility Determination; Enrollment; Esophageal; Ethnic Origin; Gender; Health Insurance; Health Services; Health Services Accessibility; Hispanics; Hospitals; Insurance; Life; Link; Liver; Malignant Neoplasms; Measures; Medicaid; Medical; Medicare; Medicare/Medicaid; Metric; Minority Groups; Monitor; New York; Operative Surgical Procedures; Outcome; Pancreas; Patients; Pattern; Patterns of Care; Performance; Persons; Population; Population Heterogeneity; Poverty; Procedures; Public Health; Quality of Care; Race; Radiation; Radiosurgery; Registries; Research Personnel; Resources; Severities; Solid Neoplasm; Source; Stage at Diagnosis; Staging; Sum; Testing; Variant; Work; aged; base; beneficiary; cancer care; cancer diagnosis; cancer surgery; cancer therapy; care delivery; chemotherapy; cohort; experience; improved; member; mortality; neoplasm registry; operation; programs; public health relevance; racial and ethnic disparities; safety net; social; tumor registry

DESCRIPTION (provided by applicant): Shortcomings in cancer care disproportionately affect minority group members and contribute to racial and ethnic disparities in cancer mortality. Many of the nearly 15 million US adults insured by Medicaid are Black or Hispanic and therefore, evaluating cancer care delivery in the context of these state health insurance programs is a logical strategy to identify the sources of disparities. By merging Medicaid enrollment and claims files with tumor registry data from New York and California, 2 states with large ethnically diverse populations and many Medicaid enrollees, we seek to identify how access to safety net health insurance and race/ethnicity intersect with common cancer diagnoses. The overarching questions we will address are: Where are there opportunities for decreasing the cancer burden for the poor? Does cancer care delivery in Medicaid achieve reasonable quality benchmarks? Do racial disparities in treatment persist within Medicaid? Specifically, we will evaluate aspects of care we understand well based on our team's prior work using Medicare-registry linked data: 1) Stage distribution at diagnosis, a marker for cancer severity and access to medical care; 2) Cancer surgery and the receipt of complex operations at experienced hospitals with high procedure volume; and, 3) Adjuvant radiation and chemotherapy treatments for cancers where these interventions improve outcomes. Analyses will focus on common solid tumors among two groups of Medicaid enrollees: adults aged 21-64 and the elderly aged 65+ dually enrolled in Medicare. We will evaluate care patterns for Medicaid patients and where data permit, compare them to patterns for otherwise similar persons not covered by Medicaid. Specifically, for each important aspect of cancer care we will also measure racial/ethnic disparities within the Medicaid program and test our hypothesis that they are minimized for patients with long term enrollment prior to diagnosis. More generally, this project will construct a resource for health services researchers, characterize its yield, and use it to identify and prioritize specific opportunities to improve cancer care delivery for vulnerable Americans. PUBLIC HEALTH RELEVANCE: Cancer care is not as good as it should be for all Americans. It is well known that care is sub-optimal for persons who are poor, many of whom are insured by State Medicaid programs. This study asks the question, is cancer care as good as it should be for patients who receive their health insurance from state Medicaid programs? Do patients who have long term access to Medicaid present with more advanced stage disease? Do they receive necessary treatments? Do the gaps in care on the basis of race and ethnicity exist within the Medicaid program? Is the information recorded on Medicaid claims reliable enough to identify important aspects of cancer treatment like surgery, radiation and chemotherapy? Could linkage of Medicaid enrollment and/or claims data to cancer registry data provide a framework for ongoing monitoring of quality of care? By examining data from New York and California which have large multiethnic populations and many persons living in poverty, this study will answer these questions and identify opportunities to improve cancer care delivery to poor Americans.

描述（由申请人提供）：癌症护理的短缺不成比例地影响少数群体成员，并导致癌症死亡率的种族和民族差异。在近1500万美国成年人中，许多人是黑人或西班牙裔，因此，在这些州健康保险计划的背景下评估癌症护理服务是确定差异来源的合理策略。通过合并医疗补助登记和索赔文件与来自纽约和加州的肿瘤登记数据，这两个州具有大量的种族多样性人口和许多医疗补助登记者，我们试图确定安全网健康保险和种族/民族与常见癌症诊断的交叉。我们要解决的首要问题是：哪里有机会减少穷人的癌症负担？医疗补助中的癌症护理服务是否达到合理的质量基准？医疗补助中的种族差异是否持续存在？具体而言，我们将根据我们团队先前的工作，使用Medicare注册相关数据，评估我们所了解的护理方面：1）诊断时的分期分布，这是癌症严重程度和获得医疗护理的标志; 2）癌症手术和在经验丰富的医院接受复杂手术，手术量大;以及3）癌症的辅助放疗和化疗治疗，这些干预措施改善了结果。分析将集中在两组医疗补助参与者中的常见实体瘤：21-64岁的成年人和65岁以上的老年人。我们将评估医疗补助患者的护理模式，并在数据允许的情况下，将其与医疗补助未覆盖的其他类似人员的模式进行比较。具体而言，对于癌症护理的每个重要方面，我们还将测量医疗补助计划中的种族/民族差异，并测试我们的假设，即对于诊断前长期登记的患者，这些差异最小化。更一般地说，该项目将为卫生服务研究人员构建一个资源，描述其产量，并利用它来确定和优先考虑改善弱势美国人癌症护理服务的具体机会。公共卫生相关性：对所有美国人来说，癌症护理并不像应该的那样好。众所周知，对于穷人来说，护理是次优的，他们中的许多人都参加了国家医疗补助计划。这项研究提出了一个问题，癌症护理是否像从州医疗补助计划中获得健康保险的患者那样好？长期获得医疗补助的患者是否患有更晚期的疾病？他们是否接受了必要的治疗？医疗补助计划中是否存在基于种族和民族的护理差距？医疗补助索赔中记录的信息是否足够可靠，以确定癌症治疗的重要方面，如手术，放疗和化疗？医疗补助登记和/或索赔数据与癌症登记数据的联系能否为持续监测护理质量提供一个框架？通过检查来自纽约和加州的数据，这两个城市有大量的多民族人口和许多生活在贫困中的人，这项研究将回答这些问题，并确定改善美国贫困人口癌症护理的机会。