Impact of Urologist Practice Structure on Prostate Cancer Care

描述（由申请人提供）：前列腺癌是一种常见且昂贵的疾病，每年的支出高达120亿美元。在过去十年中，前列腺癌的支出每年增长11%，超过了心血管和肺部疾病等其他常见疾病的增长率。这一增长部分是由于泌尿科医生自我推荐诊断和治疗服务所提供的经济激励。最近大型泌尿外科团体的激增有可能进一步扩大这些趋势。这些大型集团的形成得益于其独特的投资机会，例如提供调强放射治疗和横断面成像的昂贵设备的所有权权益。然而，支持者认为，他们的“一站式”模式为前列腺癌患者提供了更好的综合护理，最终以更低的成本获得更好的质量。因此,

DESCRIPTION (provided by applicant): Prostate cancer is a common and expensive disease with annual spending topping $12 billion. During the past decade, prostate cancer spending has increased by 11% annually, outpacing growth rates for other common conditions such as cardiovascular and pulmonary diseases. This growth is due, in part, to financial incentives afforded by urologist self-referral of diagnostic and therapeutic services. The recent proliferatio of large urology groups has the potential to further amplify these trends. The formation of these large groups has been propagated by their unique investment opportunities, such as ownership interests in expensive equipment to provide intensity modulated radiation therapy and cross-sectional imaging. However, proponents argue that their "one-stop" model results in better care integration for men with prostate cancer, ultimately yielding better quality at a lower cost. Thus, the goal of this national study is to better understand relationships between urologist practice organization and the quantity, quality and cost of prostate cancer care. To examine this issue more carefully, this grant has the following three aims. Aim 1. To assess relationships between urologist practice organization and prostate cancer utilization. Using national Medicare and SEER-Medicare data, we will measure how prostate cancer detection and treatment are mediated by urologist group practice structure. Aim 2. To measure relationships between urologist practice organization and the quality of prostate cancer care. Using similar methods, we will determine the effect of urologist practice structure on the quality of prostate cancer care including adherence to nationally endorsed standards and the breadth of overuse. Aim 3. To assess relationships between urologist practice organization and prostate cancer expenditures. We will measure the association between urologist practice structure and national Medicare payments, both per capita (i.e., average overall spending) and per episode surrounding local treatment. This proposal has real-world implications for all prostate cancer stakeholders. First, our findings with respect to quality have immediate implications for patients, who are logically interested in mechanisms for improving the quality of prostate care delivered. Second, understanding the relative efficiency of prostate cancer care is of immediate interest to payers and policymakers as they explore strategies to improve quality while limiting unnecessary spending growth.