A Comprehensive Model to Assess the Cost-Effectiveness of Patient Navigation

描述（由申请人提供）： 患者导航（PN）是一种以社区为中心的方法，可以通过在疾病连续体的早期阶段为服务不足的人群（如种族/族裔少数群体或社会经济地位低的个人）提供更多的护理来减少健康差异。到目前为止，有两个大规模的联邦资助项目涉及PN干预;一个是由国家癌症研究所（NCI）赞助的患者导航研究项目;另一个是由医疗保险和医疗补助服务中心（CMS）支持的一系列示范项目。NCI申办的研究中心大多在检测到异常筛查结果时启动PN服务，而CMS申办的研究中心尝试在早期阶段参与PN服务，以增加癌症筛查的使用。与常规护理（UC）相比，两种PN服务的成本效益知之甚少。拟议研究的目的是制定一个全面的研究框架，以评估针对癌症护理连续体（筛查、诊断和治疗）中各个点的PN计划的成本效益。该研究有三个具体目标：（1）评估常规护理与检测到异常筛查结果时开始的患者导航之间的成本效益;（2）比较常规护理与旨在提高癌症筛查接受率的患者导航之间的成本效益;以及（3）评估在癌症护理连续体的不同时间点启动的患者导航程序之间的成本效益。该研究将利用从德克萨斯大学医学博士的CMS示范点开发的数据库。安德森癌症中心，补充医疗保险索赔和从文献中获得的信息，以评价PN与UC的短期和长期成本效益。研究的视角将包括社会，支付者和医疗保健提供者，他们雇用患者导航员为患者或周围社区的高危人群提供服务。我们将在短期分析中使用患者水平数据采用适当的成本效益分析统计方法，并将开发癌症特异性马尔可夫模型以评估长期成本效益。拟议研究的结果将告知政策制定者在癌症护理连续体的不同时间点开始的PN与UC的成本，比较有效性和成本效益，以及在不同时间点开始的PN服务之间的比较。此外，我们会发展一个方便使用的模式，以研究肠外营养的成本效益;其他肠外营养服务的介入地点亦可应要求使用该模式。患者导航是一种以社区为中心的方法，可以通过提高服务不足人群在疾病早期阶段获得护理的机会来减少健康差距。这项研究将开发一个全面的和用户友好的模型，比较患者导航和导航服务在癌症护理连续体的不同时间点启动的常规护理的成本效益。我们将从三个不同的利益群体：整个社会、保险支付者和医疗保健提供者，讨论短期和长期的成本效益PN服务。

DESCRIPTION (provided by applicant): Patient navigation (PN) is a community-centered approach that can potentially reduce health disparities by enhancing access to care at an earlier stage of the disease continuum for underserved populations, such as racial/ethnic minorities or individuals with low socioeconomic status. To date there are two large-scale federally-funded programs that involve PN interventions; one is the patient navigation research program sponsored by the National Cancer Institute (NCI); the other is a series of demonstration projects supported by Centers for Medicare and Medicaid Services (CMS). The NCI-sponsored sites mostly initiate PN services at the time an abnormal screening result is detected, whereas the CMS- sponsored sites attempt to engage PN services at an earlier stage so as to increase the uptake of cancer screening. Little is known about the cost-effectiveness of PN compared to usual care (UC) for either type of PN services. The objective of the proposed study is to develop a comprehensive research framework to assess the cost-effectiveness of a PN program targeted at various points in the continuum of cancer care - screening, diagnosis, and treatment. The study has three specific aims: (1) to evaluate the cost-effectiveness between usual care and patient navigation started at the time that an abnormal screening result was detected; (2) to compare the cost-effectiveness between usual care and patient navigation targeted at improving the uptake of cancer screening; and (3) to assess the cost-effectiveness between patient navigation programs initiated at various time points of the cancer care continuum. The study will utilize databases developed from the CMS demonstration site at University of Texas M.D. Anderson Cancer Center, supplemented with Medicare claims and information obtained from the literature, to evaluate the short-term and long-term cost-effectiveness of PN versus UC. Study perspective will include that of society, payors, and health care providers that employ patient navigators to facilitate services for their patients or the at-risk population in the surrounding neighborhood. We will employ appropriate statistical methods of cost-effectiveness analyses using patient-level data in the short-term analysis and will develop cancer-specific Markov models to assess the long-term cost-effectiveness. Findings from the proposed study will inform policy makers on the costs, comparative effectiveness, and cost-effectiveness of PN versus UC initiated at various time points of the cancer care continuum, as well as the comparison between PN services started at different time points. In addition, a user-friendly model will be developed for the study of the cost- effectiveness of PN; the model will be available to other intervention sites of PN services upon request. Patient navigation is a community-centered approach that can potentially reduce health disparities by enhancing access to care at an earlier disease stage for underserved populations. This study will develop a comprehensive and user-friendly model to compare the cost-effectiveness of patient navigation and usual care for navigation services initiated at different time points of the cancer care continuum. We will address both short-term and long- term cost-effectiveness PN services from three different interest groups: societal as a whole, insurance payors, and health care providers.