Cancer, Care Coordination, and Medication Use for Multiple Chronic Conditions

 描述（由申请人提供）：多种慢性疾病（MCC）代表了美国老年人的重大健康问题。医学研究所提出了加强护理协调的建议，认为这是提高所有患者，特别是MCC患者护理质量的一种有前途的方法。这是许多平价医疗法案改革的关键特征，如以患者为中心的医疗之家（MH）和北卡罗来纳州社区护理（CCNC）医疗补助医疗之家计划的中心焦点。MCC的负担和对护理协调的需求在患有癌症的老年人群中特别明显，这是美国不断增长的人口。MCC可以使癌症治疗决策复杂化，并且通常是癌症幸存者死亡的主要原因。本研究的目的是调查与无癌患者相比，65岁以后诊断的癌症患者中MCC的管理。本研究将分析患有糖尿病、高脂血症和/或高血压的复杂老年患者，这些患者被诊断患有四种最常见的癌症（乳腺癌、结直肠癌和肺癌）。和前列腺），其使用两个来源的关联癌症登记和行政索赔来确定：监测、流行病学和最终结果计划（SEER）-医疗保险数据库和与医疗补助和医疗保险索赔关联的北卡罗来纳州中央癌症登记。我们将扩大分析的范围，相对于现有的文献，包括管理MCC之前的癌症诊断，治疗期间，并进入生存期。我们假设，药物依从性（目标1）将在不同阶段的护理和癌症部位相对于非癌症对照组。这项研究的结果旨在确定癌症部位和护理阶段，其中对护理协调和药物依从性的额外支持可能至关重要。我们还将使用基于索赔的协调措施（目标2）和CCNC医疗之家计划（目标3）中的登记情况，评估护理协调水平是否会改变依从性的变化。我们的研究将及时提供证据，证明改善护理协调和MH对老年复杂癌症患者的药物依从性的影响，包括全国最大的MH计划。

 DESCRIPTION (provided by applicant): Multiple chronic conditions (MCC) represent a substantial health problem for older adults in the United States. Increasing the coordination of care has been proposed by the Institute of Medicine as one promising approach for improving the quality of care for all patients, and particularly those with MCC. It is a key feature of many Affordable Care Act reforms such as patient-centered medical homes (MHs) and a central focus of the Community Care of North Carolina (CCNC) Medicaid medical home program. Both the burden of MCC and the need for care coordination are particularly notable within the older population with cancer, a growing demographic in the United States. MCC can complicate cancer treatment decisions and often are the leading cause of death for cancer survivors. The goal of this study is to investigate the management of MCC among cancer patients diagnosed after the age of 65 compared with cancer-free patients. This study will analyze complex older patients with diabetes, hyperlipidemia, and/or hypertension diagnosed with the four most common cancers (breast, colorectal, lung. and prostate) identified using two sources of linked cancer registry and administrative claims: the Surveillance, Epidemiology, and End Results program (SEER)-Medicare database and North Carolina Central Cancer Registry linked to Medicaid and Medicare claims. We will expand the horizon of analysis, relative to existing literature, to include management of MCC before the cancer diagnosis, during treatment, and into the survivorship phase. We hypothesize that medication adherence (Aim 1) will vary across phases of care and by cancer site relative to the non-cancer comparison group. The results of this study aim will identify cancer sites and phases of care in which additional support for care coordination and medication adherence may be crucial. We will also evaluate whether the level of care coordination modifies changes in adherence using claims-based measures of coordination (Aim 2) and enrollment in the CCNC medical home program (Aim 3). Our study will produce timely evidence of the effect of improved care coordination and MHs on medication adherence for older, complex cancer patients, including the nation's largest MH program.