Understanding optimal delivery systems for cancer care

了解癌症治疗的最佳输送系统

• 批准号: 8628565
• 负责人: David C Miller
• 金额: $ 48.66万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628565
• 关键词: Accountability; Acute; Adherence; Advocate; Age-Years; Behavior; Cancer Hospital; Caring; Clinical; Clinical Services; Complex; Data; Diagnosis; Diagnostic; Disease; Evaluation; Expenditure; Foundations; Guidelines; Health system; Healthcare; Hospital Societies; Hospitalization; Hospitals; Integrated Delivery Systems; Intervention; Link; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Measures; Medical Surveillance; Medicare; Medicare claim; Methods; Modeling; Oncologist; Operative Surgical Procedures; Outcome; Patient Care; Patients; Phase; Physicians; Policies; Primary Care Physician; Provider; Recommendation; Research; Savings; Specialist; Specific qualifier value; System; Systemic Therapy; Systems Integration; Time; United States; United States Centers for Medicare and Medicaid Services; Work; base; cancer care; cancer diagnosis; cancer therapy; cancer type; care delivery; cohort; comparative; cost; end of life; evidence base; financial incentive; improved; long term hospitalization; malignant breast neoplasm; medical specialties; mortality; oncology; patient population; payment; public health relevance; survivorship

Project Summary The quality and cost of cancer care vary widely across hospitals and health systems. A large body of research indicates that hospitals with better outcomes tend to have large case volumes and a defined focus on cancer care. These and other data have prompted many to advocate for specialized cancer hospitals-so-called "focused factories"-as the best delivery system for achieving more efficient cancer care. However, reforms in the Affordable Care Act, including Accountable Care Organizations (ACO), are moving care away from this model. Although proponents argue that ACOs will improve efficiency by encouraging previously unaligned hospitals and physicians to evolve toward integrated delivery systems, others worry that the intended benefits will not accrue for patients with complex cancer diagnoses, and that ACOs will discourage referrals to hospitals with the greatest cancer expertise. To explore this issue, we propose a study that evaluates comprehensively the relationship between care delivery models and the quality, outcomes, and cost of cancer care in the United States. In the first aim, we will examine the impact of care delivery models on the quality of cancer care. Using national Medicare claims and linked SEER-Medicare data, we will identify cohorts of patients with breast, lung, prostate, and pancreatic cancer. We will then compare the quality of cancer care provided in different care delivery models based on levels of adherence with guideline recommendations and/or nationally-endorsed quality measures. We posit that cancer-focused hospitals will often have higher levels of adherence, due in part to their greater concentration of disease-specific expertise. In the second aim, we will assess the association between care delivery models and outcomes, including operative mortality, complications, hospitalizations, and long-term survival. We hypothesize that patients treated in cancer-focused hospitals will have better mortality outcomes, while greater delivery system integration will correlate with fewer hospitalizations following initial cancer therapy. In the third aim, we will examine cancer-related expenditures for these patient cohorts as they vary over time after diagnosis. We will also assess payments related to different clinical services including surgical procedures, systemic therapy, end-of-life care, and non-cancer-related treatments. We expect that cancer-focused hospitals will achieve savings around episodes of surgical care, and that patients treated in more integrated delivery systems will have lower longitudinal costs for their cancer care. Results from this study will prove invaluable to CMS policymakers and other stakeholders as they debate whether delivery system reforms deemed good for healthcare in general are also good for patients with cancer.

项目摘要 癌症护理的质量和成本在医院和卫生系统之间差异很大。大 大量研究表明，治疗效果较好的医院往往有大量的病例 以及明确的癌症治疗重点。这些和其他数据促使许多人主张 专门的癌症医院-所谓的“集中工厂”-作为最好的输送系统， 实现更有效的癌症治疗。然而，《平价医疗法案》的改革，包括 问责护理组织（ACO）正在使护理远离这种模式。虽然 支持者认为，ACO将通过鼓励以前不一致的做法来提高效率 医院和医生向综合交付系统发展，其他人担心， 对于患有复杂癌症诊断的患者，预期的益处不会增加，并且ACO将 不鼓励将病人转诊到有最好的癌症专业知识的医院。为了探讨这个问题，我们 提出一项研究，全面评估护理提供模式之间的关系， 以及美国癌症治疗的质量、结果和成本。在第一个目标中，我们将 检查护理提供模式对癌症护理质量的影响。利用国家 医疗保险索赔和相关的SEER医疗保险数据，我们将确定乳腺癌患者的队列， 肺癌前列腺癌和胰腺癌然后，我们将比较所提供的癌症护理的质量 在基于对指南建议的遵守程度的不同护理提供模式中 和/或国家认可的质量措施。我们认为，以癌症为重点的医院往往会 有更高的坚持水平，部分原因是他们更集中的疾病特异性 专业知识在第二个目标中，我们将评估护理提供模式与 结果，包括手术死亡率、并发症、住院和长期生存。 我们假设在以癌症为重点的医院治疗的患者会有更好的死亡率 结果，而更大的输送系统集成将与更少的住院相关 在最初的癌症治疗之后。在第三个目标中，我们将审查与癌症有关的支出， 这些患者队列，因为它们在诊断后随时间变化。我们还将评估付款 与不同的临床服务相关，包括外科手术、全身治疗、临终关怀 护理和非癌症相关治疗。我们希望以癌症为重点的医院能够实现 节省了手术护理的费用，患者在更综合的分娩中接受治疗， 系统将具有较低的癌症护理纵向成本。这项研究的结果将 对CMS决策者和其他利益相关者来说是非常宝贵的，因为他们正在讨论交付是否 一般认为有利于医疗保健的系统改革对癌症患者也有好处。