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

描述(由申请人提供)： 病人导航(PN)是一种以社区为中心的方法，它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/少数民族或社会经济地位较低的个人)增加获得护理的机会，潜在地减少健康差距。到目前为止，有两个由联邦政府资助的涉及PN干预的大型项目；一个是由美国国家癌症研究所(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赞助的网站大多在检测到异常筛查结果时启动PN服务，而CMS赞助的网站试图在较早阶段进行PN服务，以增加癌症筛查的接受度。对于任何一种类型的PN服务，PN与常规护理(UC)相比的成本效益知之甚少。这项拟议研究的目的是开发一个全面的研究框架，以评估针对癌症护理-筛查、诊断和治疗-连续体中的不同点的PN计划的成本效益。这项研究有三个具体目标：(1)评估在检测到异常筛查结果时开始的常规护理和患者导航之间的成本效益；(2)比较常规护理和旨在提高癌症筛查接受度的患者导航之间的成本效益；以及(3)评估在癌症护理连续过程的不同时间点启动的患者导航计划之间的成本效益。这项研究将利用得克萨斯大学M.D.安德森癌症中心CMS示范点开发的数据库，并辅之以从文献中获得的医疗保险声明和信息，以评估PN与UC的短期和长期成本效益。研究视角将包括社会、付款人和医疗保健提供者，他们使用患者导航器来促进为他们的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采用适当的统计方法，使用患者水平的数据进行成本-效果分析，并将开发针对癌症的马尔可夫模型来评估长期成本-效果。拟议研究的结果将使决策者了解在癌症护理连续过程的不同时间点开始的PN和UC的成本、比较效果和成本效益，以及在不同时间点开始的PN服务之间的比较。此外，还将开发一种便于用户使用的模式，用于研究个人卫生服务的成本效益；根据要求，该模型将适用于其他个人卫生服务干预地点。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获得护理的机会来潜在地减少健康差距。这项研究将开发一个全面的、用户友好的模型，以比较在癌症护理连续过程的不同时间点启动的导航服务的患者导航和常规护理的成本效益。我们将解决来自三个不同利益集团的短期和长期具有成本效益的PN服务：社会整体、保险支付者和医疗保健提供者。

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.