The Revolving Door of Cancer Care For Older Americans

描述（由申请人提供）：尽管医学治疗取得了重大进展，但癌症仍然是美国第二大死亡原因，每两个癌症患者中就有一个死于他/她的疾病。重病和垂死的癌症患者经常被困在急症护理医院和疗养院（NH）的旋转门内。我们的初步工作发现，近三分之一被诊断为癌症的医疗保险受益人在生命的最后90天内进入了NH，在生命的最后3天内发生了许多转变。在本应用中，我们建议基于合并的最小数据集和医疗保险索赔文件，通过创建前瞻性和回顾性癌症患者队列来量化医疗保健转换和即将开发的潜在负担转换措施，来检查癌症治疗的质量。目前的保健过渡措施侧重于出院，而一个重要的问题是住院（即过渡）首先是否适当。利用改进的德尔菲技术与焦点小组和专家咨询小组，我们建议制定潜在繁重的过渡措施（具体目标I），记录其变化，并检查这些拟议的前瞻性和回顾性措施的个人，组织特征和健康市场关联（具体目标II）。虽然基于医疗保险索赔的质量指标实施起来相对便宜，但一个重要的问题是不知道在每一项拟议措施中观察到的变化是否反映了知情的患者偏好。因此，作为该申请的一部分，我们将开展一项初步工作，为R01拨款申请制定一项调查抽样策略，该策略将通过对丧亲者家庭成员的调查来验证这些基于索赔的措施，这些调查使用现有的、经过验证的调查措施来检查护理协调以及癌症护理是否以患者和家庭为中心（具体目标III）。医学研究所，绩效薪酬（P4P）和负责任的医疗机构的发展要求制定措施，检查医疗保险受益人的纵向经验。该项目的结果将提供基于索赔的措施，可用于评估《2010年患者保护和平价医疗法案》为创建负责任的医疗机构所做的努力，旨在促进医疗的整合和协调。这些措施可能有助于了解如何最好地为晚期癌症患者组织医疗保健。

DESCRIPTION (provided by applicant): Despite important advances in medical treatment, cancer remains the second leading cause of death in the USA with one in two cancer patients dying of his/her disease. Often seriously ill and dying cancer patients are caught within the revolving door of the acute care hospital and the nursing home (NH). Our preliminary work found that nearly one in three Medicare beneficiary decedents with a diagnosis of cancer are in a NH in the last 90 days of life, with many transitions in the last 3 days of life. In this application, we propose to examine the quality of cancer care based on merged Minimum Data Set and Medicare Claims files by creating both prospective and retrospective cohorts of cancer patients to quantify health care transitions and to-be- developed measures of potentially burdensome transitions. Current measures of health care transitions focus on the discharge from the hospital when an important concern is whether that hospitalization (i.e. transition) was appropriate in the first place. Using a modified Delphi technique with focus groups and expert advisory panel, we propose to develop measures of potentially burdensome transitions (Specific Aim I), document their variation, and examine the individual, organizational characteristics, and health market association of these proposed prospective and retrospective measures (Specific Aim II). While quality indicators based on Medicare claims are relatively inexpensive to implement, an important catch is not knowing whether the observed variation in each of the proposed measures reflects informed patient preferences. Thus, as part of this application, we will undertake a preliminary work to develop a survey sampling strategy for an R01 grant application that will validate these claims based measures with surveys of bereaved family members using existing, validated survey measures that examine care coordination and whether cancer care is patient- and family-centered (Specific Aims III). The Institute of Medicine, pay for performance (P4P), and the development of accountable care organizations call for development of measures that examine the longitudinal experience of Medicare beneficiaries. The results of this project will provide claims-based measures that could be used to evaluate Patient Protection and Affordable Care Act of 2010 efforts to create accountable care organizations, which aim to foster integration and coordination of care. Such measures potentially could help inform how best to structure health care for persons with advanced cancer. PUBLIC HEALTH RELEVANCE: An important goal of health care reform is reduce the fragmentation of our health care system lead to health care transitions that may result in medical errors, inadequate care coordination, and can be potentially burdensome for seriously ill cancer patients and their family. Quality measures that examine the longitudinal of experience of Medicare Beneficiaries diagnosed with cancer are needed to highlight the opportunity to improve. The proposed research will develop proposed measures of potentially burdensome transitions, a pattern of transfer between health care institutions in which experts, health care providers, and consumers would raise a concern with the quality of care.