Impact of Urologist Practice Structure on Prostate Cancer Care

描述(申请人提供)：前列腺癌是一种常见且昂贵的疾病，每年的支出超过120亿美元。在过去的十年中，前列腺癌的支出以每年11%的速度增长，超过了心血管和肺部疾病等其他常见疾病的增长速度。这一增长在一定程度上是由于泌尿科医生自我转诊诊断和治疗服务所提供的经济激励。最近大型泌尿外科组织的激增有可能进一步放大这些趋势。这些大型集团的形成得益于它们独特的投资机会，例如拥有提供强度调制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”模式为前列腺癌男性患者带来了更好的护理整合，最终以更低的成本产生了更好的质量。因此， 这项全国性研究的目的是为了更好地了解泌尿科医生执业组织与前列腺癌护理的数量、质量和成本之间的关系。为了更仔细地研究这个问题，这笔赠款有以下三个目标。目的1.评估泌尿科医生执业组织与前列腺癌利用的关系。使用国家医疗保险和SEER-Medicare数据，我们将衡量前列腺癌的检测和治疗是如何通过泌尿科医生小组的执业结构进行调节的。目的2.测量泌尿科医生执业组织与前列腺癌护理质量的关系。使用类似的方法，我们将确定泌尿科医生执业结构对前列腺癌护理质量的影响，包括遵守国家认可的标准和过度使用的广度。目的3.评估泌尿科医师执业机构与前列腺癌费用的关系。我们将衡量泌尿科医生的执业结构和国家医疗保险支付之间的关系，包括人均(即平均总支出)和围绕当地治疗的每一次发作。这项提议对所有前列腺癌利益相关者都有现实意义。首先，我们在质量方面的发现对患者有直接的影响，他们在逻辑上对改善前列腺护理提供的质量的机制感兴趣。其次，了解前列腺癌护理的相对效率对支付者和政策制定者来说是直接感兴趣的，因为他们正在探索提高质量的策略，同时限制不必要的支出增长。

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.