Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis.
Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis.
复制标题
DOI：
10.1001/jamanetworkopen.2022.22214
复制
发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Leapman, Michael S.
中科院分区：
文献类型：
--
作者：
Marks, Victoria A.;Hsiang, Walter R.;Nie, James;Demkowicz, Patrick;Umer, Waez;Haleem, Afash;Galal, Bayan;Pak, Irene;Kim, Dana;Salazar, Michelle C.;Berger, Elizabeth R.;Boffa, Daniel J.;Leapman, Michael S.
医疗补助保险的个人可以在高绩效的癌症指定医院获得癌症护理服务吗？在这项对334家癌症护理机构的横断面研究中，95.5%的乳腺癌患者接受了医疗补助，90.4%的结直肠癌患者接受了医疗补助，86.8%的肾癌患者接受了医疗补助，79.6%的皮肤癌患者接受了医疗补助。医疗补助被接受的所有4个调查的癌症在67.7%的设施。尽管通过医疗补助计划投保的美国居民人数有所增加，但这些发现表明，在高质量的中心，获得癌症护理的障碍仍然存在。这项横断面研究评估了被诊断患有常见癌症的患者对医疗补助保险的设施级接受程度。尽管通过医疗补助计划投保的美国居民人数大幅增加，但医疗补助计划患者获得癌症护理服务的能力却鲜为人知。评估诊断为常见癌症的患者对医疗补助保险的设施级接受程度。这项全国性的横断面秘密购物者研究于2020年在美国癌症委员会认证的机构中随机抽样进行，使用了一组患有结直肠癌、乳腺癌、肾癌和黑色素瘤皮肤癌的医疗补助保险成年患者的模拟队列。电话呼叫，要求为新诊断为癌症的Medicaid患者进行预约。接受癌症医疗补助保险。采用描述性统计、χ2检验和多变量逻辑回归模型来检验与结直肠癌、乳腺癌、肾癌和皮肤癌的医疗补助接受度相关的因素。高访问医院被定义为提供所有4种癌症类型的医疗服务。解释性措施包括来自2016年美国医院协会年度调查和医疗保险和医疗补助服务中心一般信息数据库的设施级因素。创建了334个具有全国代表性的样本机构，其中226个机构（67.7%）为寻求癌症护理的医疗补助患者提供了很高的机会。医疗补助的接受程度因癌症部位而异，319家机构（95.5%）接受乳腺癌医疗补助保险; 302家（90.4%），结直肠癌; 290家（86.8%），肾脏; 266家（79.6%），皮肤。综合社区癌症项目（OR，0.4; 95%CI，0.2-0.7; P = 0.007）显著降低了医疗补助患者获得高水平护理的可能性。与非政府、非营利组织合作的设施（与营利性：OR，3.5; 95% CI，1.1-10.8; P = .03）和政府（与营利性组织相比：OR，6.6; 95% CI，1.6-27.2; P = .01）所有权、综合薪酬模式（OR，2.6; 95% CI，1.5-4.5; P = .001），平均（高于平均值：OR，6.4; 95% CI，1.4-29.6; P = .02）或低于平均值（与高于平均水平：OR，8.4; 95% CI，1.5-47.5; P = 0.02）护理的有效性与获得医疗补助的机会高相关。州医疗补助扩展状态与高可及性无显著相关。这项研究确定了在指定的高质量护理中心享受医疗补助保险的患者的准入差异。这些发现突出了癌症护理的差距，不断扩大的患者接受医疗补助。
Can individuals insured by Medicaid access cancer care services at high-performing cancer-designated hospitals? In this cross-sectional study of 334 facilities recognized for cancer care, 95.5% accepted new patients with Medicaid for breast cancer, 90.4% for colorectal cancer, 86.8% for kidney cancer, and 79.6% for skin cancer (melanoma) care. Medicaid was accepted for all 4 surveyed cancers at 67.7% of facilities. Despite increases in the number of US residents insured through Medicaid, these findings suggest that barriers to accessing cancer care exist at high-quality centers. This cross-sectional study evaluates facility-level acceptance of Medicaid insurance among patients diagnosed with common cancers. Although there have been significant increases in the number of US residents insured through Medicaid, the ability of patients with Medicaid to access cancer care services is less well known. To assess facility-level acceptance of Medicaid insurance among patients diagnosed with common cancers. This national cross-sectional secret shopper study was conducted in 2020 in a random sample of Commission on Cancer–accredited facilities in the United States using a simulated cohort of Medicaid-insured adult patients with colorectal, breast, kidney, and melanoma skin cancer. Telephone call requesting an appointment for a patient with Medicaid with a new cancer diagnosis. Acceptance of Medicaid insurance for cancer care. Descriptive statistics, χ2 tests, and multivariable logistic regression models were used to examine factors associated with Medicaid acceptance for colorectal, breast, kidney, and skin cancer. High access hospitals were defined as those offering care across all 4 cancer types surveyed. Explanatory measures included facility-level factors from the 2016 American Hospital Association Annual Survey and Centers for Medicare & Medicaid Services General Information database. A nationally representative sample of 334 facilities was created, of which 226 (67.7%) provided high access to patients with Medicaid seeking cancer care. Medicaid acceptance differed by cancer site, with 319 facilities (95.5%) accepting Medicaid insurance for breast cancer care; 302 (90.4%), colorectal; 290 (86.8%), kidney; and 266 (79.6%), skin. Comprehensive community cancer programs (OR, 0.4; 95% CI, 0.2-0.7; P = .007) were significantly less likely to provide high access to care for patients with Medicaid. Facilities with nongovernment, nonprofit (vs for-profit: OR, 3.5; 95% CI, 1.1-10.8; P = .03) and government (vs for-profit: OR, 6.6; 95% CI, 1.6-27.2; P = .01) ownership, integrated salary models (OR, 2.6; 95% CI, 1.5-4.5; P = .001), and average (vs above-average: OR, 6.4; 95% CI, 1.4-29.6; P = .02) or below-average (vs above-average: OR, 8.4; 95% CI, 1.5-47.5; P = .02) effectiveness of care were associated with high access to Medicaid. State Medicaid expansion status was not significantly associated with high access. This study identified access disparities for patients with Medicaid insurance at centers designated for high-quality care. These findings highlight gaps in cancer care for the expanding population of patients receiving Medicaid.
登录
查看更多内容
DOI：
10.1016/j.jamcollsurg.2020.10.021
发表时间：
2021-03
影响因子：
5.2
作者：
Hoehn RS;Rieser CJ;Phelos H;Sabik LM;Nassour I;Paniccia A;Zureikat AH;Tohme ST
通讯作者：
Tohme ST
影响因子：
3
作者：
Hall, Erin C.;Zheng, Chaoyi;Al-Refaie, Waddah B.
通讯作者：
Al-Refaie, Waddah B.
影响因子：
--
作者：
Hamlyn, Geoffrey S.;Hutchins, Kathryn E.;Kamal, Arif H.
通讯作者：
Kamal, Arif H.
影响因子：
3.8
作者：
Courtemanche, Charles;Marton, James;Zapata, Daniela
通讯作者：
Zapata, Daniela
影响因子：
45.3
作者：
Goss, Elizabeth;Lopez, Ana Maria;Raghavan, Derek
通讯作者：
Raghavan, Derek