Multidimensional access and prostate cancer treatment disparities

项目总结（见说明）： 癌症治疗中的种族差异得到了很好的描述，但了解甚少。虽然大多数专家认为，获得保健的机会是造成这些差距的原因之一，但弱势群体获得保健是一个复杂、多层面的过程，保险范围或旅行时间的衡量标准无法充分反映这一点。在这个应用程序中，我们建议建立在我们以前的研究种族差异，前列腺癌的治疗和获得护理，调查的贡献，一个多维的图片，医疗保健获得种族差异，前列腺癌治疗。 我们将收集大费城地区8个县诊断为局限性前列腺癌的男性（N= 3，000）人群样本以及接受前列腺癌治疗的泌尿科医生和放射肿瘤学家的主要数据。我们将重点关注这一领域，因为它是拟议中心的主要重点，因为城市人口中癌症护理的多个方面知之甚少。在Penchansky和托马斯的访问框架的基础上，我们将评估前列腺癌护理的可及性/可用性，住宿，负担能力和可接受性，使用患者调查，行政记录和供应商库存的数据。在Aday & Andersen的框架下，我们将创建潜在访问的空间测量和经验访问的个体测量（一种实现访问的形式）。我们将使用患者的经验数据，以及来自AMA主文件的关于提供者委员会认证和培训的数据，整合有关提供者特征的信息。然后，我们将研究潜在的访问之间的关系，经验丰富的访问，和治疗的差异，以及在何种程度上这些影响是由保险范围，社会经济地位和邻里剥夺介导的。据我们所知，这将是第一项通过收集来自患者，提供者和管理来源的信息来构建一个全面，多维的癌症护理获取情况的研究，并使用该图片来提高我们对癌症治疗种族差异的理解。

PROJECT SUMMARY (See instructions): Racial disparities in cancer treatment are well described but poorly understood. Although most experts believe that access to care contributes to these disparities, access for vulnerable populations is a complex, multidimensional process that is inadequately captured by measures of insurance coverage or travel time. In this application, we propose to build upon our prior researching racial disparities, prostate cancer treatment and access to care to investigate the contribution of a multidimensional picture of health care access to racial differences in prostate cancer treatment. We will collect primary data on a population based sample of men diagnosed with localized prostate cancer (N=3,000) in 8 counties in the Greater Philadelphia area and on the urologists and radiation oncologists who form their access to prostate cancer treatment. We will focus on this area as it is the primary focus of the proposed center and because the multiple dimensions of cancer care in urban populations are poorly understood. Building on the access framework of Penchansky and Thomas, we will assess the accessibility /availability, accommodation, affordability, & acceptability of prostate cancer care, using data from a patient survey, administrative records, & a provider inventory. Following the framework of Aday & Andersen, we will create spatial measures of potential access & individual measures of experienced access (a form of realized access). We will incorporate information about the characteristics of providers using data from patients about their experiences, as well as data from the AMA masterfile about provider board certification and training. We will then examine the relationships between potential access, experienced access, & differences in treatment as well as the degree to which these effects are mediated by insurance coverage, socioeconomic status & neighborhood deprivation. To our knowledge, this will be the first study to construct a comprehensive, multi-dimensional picture of access to cancer care by collecting information from patients, providers & administrative sources & to use this picture to improve our understanding of a racial difference in cancer treatment.