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

 描述(由申请人提供)：在美国，多种慢性病(MCC)对老年人来说是一个严重的健康问题。医学研究所建议加强护理协调，作为改善所有患者，特别是MCC患者的护理质量的一种有希望的方法。这是许多《平价医疗法案》改革的关键特征，例如以患者为中心的医疗之家(MHS)和北卡罗来纳州社区护理(CCNC)医疗补助医疗之家计划的核心重点。MCC的负担和护理协调的需要在患有癌症的老年人口中尤其明显，这在美国日益增长的人口中。MCC会使癌症治疗决策复杂化，而且往往是癌症幸存者的主要死亡原因。本研究的目的是探讨65岁以后确诊的癌症患者与非癌症患者的微循环处理情况。这项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，这些患者被诊断为四种最常见的癌症(乳腺癌、结直肠癌、肺癌)。和前列腺癌)使用两个相关联的癌症登记和行政索赔来源确定：监测、流行病学和最终结果计划(SEER)-联邦医疗保险数据库和北卡罗来纳州中央癌症登记与联邦医疗补助和联邦医疗保险索赔相关联。相对于现有的文献，我们将扩大分析的范围，以包括在癌症诊断之前、治疗期间以及进入生存阶段之前对MCC的处理。我们假设，与非癌症对照组相比，药物依从性(目标1)将随护理阶段和癌症部位的不同而不同。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是至关重要的。我们还将使用基于索赔的协调措施(目标2)和参加CCNC医疗之家计划(目标3)来评估护理协调水平是否改变了遵从性的变化。我们的研究将及时提供证据，证明改善护理协调和医疗保健制度对老年复杂癌症患者服药依从性的影响，包括全国最大的医疗保健计划。

 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.