Enriching Claims-Based Analysis of Prostate Cancer Treatment Decision Making

描述(申请人提供)：背景：前列腺癌是一种常见疾病，主要影响老年男性。患有低风险疾病的男性通常是很好的观察对象，而那些有高风险疾病和其他有利预期寿命的男性通常是很好的治疗对象。在这两种情况下，通过适当地选择患者进行观察和治疗，可以实现出色的癌症控制和较低的发病率。然而，前列腺癌的治疗很少能达到这一理想。治疗过度和治疗不足的比率都很高。解释这些观察结果的假设包括医疗保健提供系统支离破碎，以及参与前列腺癌治疗决策的专家缺乏预测技能。相比之下，老年护理模式寻求跨提供者和环境的护理整合，促进共享决策，并使用功能状态知情预测模型。基于联邦医疗保险索赔的前列腺癌治疗模式分析提供了关于过度和不足治疗的原因和后果的唯一具有全国代表性的数据。利用索赔更深入地理解这些现象的关键障碍是缺乏关于负责受益人护理的提供者网络的信息，以及缺乏关于受益人功能状况的临床相关信息。目的：本建议的首要目标是通过以下方式解决这些关键障碍：1)开发提供者责任和护理归因的经验性测量；2)探索功能状态和与健康相关的生活质量对治疗决策的影响。具体目标：1)在SEER-Medicare数据中经验性地得出医生-医院网络(PHN)，用于未来描述老年人前列腺癌的治疗模式和结果；以及2)探索功能状况对老年人前列腺癌治疗模式的影响。研究设计：我们将使用SEER-Medicare来开发初级保健和前列腺癌治疗，以PHN为基础，然后分析假设与过度和不足治疗相关的PHN属性(目标1)。我们将使用SEER-Medicare健康结果调查数据，并结合广义估计方程来检查前列腺癌治疗前后患者报告的、以老年人为重点的措施(目标2)。与国家老龄研究所的相关性：这项提案的发现将解决基于索赔的相关分析的关键障碍 由于提供者的责任/护理归属以及缺乏关于患者报告的措施的信息。该提案将提供以老年为重点的指导和方法经验，包括接触PHN和功能状态测量。这些机会将为检查与更好的治疗目标相关的提供者因素以及评估功能状态和前列腺癌治疗决策之间的关系奠定基础。

DESCRIPTION (provided by applicant): Background: Prostate cancer is a common disease that predominantly affects older men. Men with low-risk disease are frequently good candidates for observation, while those with high-risk disease and otherwise favorable life expectancy are often good candidates for treatment. In both situations, excellent cancer control with low morbidity can be achieved by appropriately selecting patients for observation versus treatment. Yet the management of prostate cancer seldom meets this ideal. High rates of both over and undertreatment exist. Hypotheses posited to explain these observations include a fragmented healthcare delivery system and lack of skill in prognostication among specialists involved in prostate cancer treatment decisions. In contrast, geriatric models of care seek to integrate care across providers and settings, promote shared decision-making, and use models of functional-status informed prognostication. Medicare claims-based analyses of prostate cancer treatment patterns offer the only nationally-representative data on the causes and consequences of over and undertreatment. Critical barriers to a deeper understanding of these phenomena using claims are lack of information regarding the provider networks responsible for beneficiaries' care and lack of clinically relevant information about beneficiary functional status. Objective: The overarching goal of this proposal is to address these critical barriers by: 1) developing empiric measurements of provider accountability and care attribution; and 2) exploring the influence of functional status and health-related quality of life on treatment decision making. Specific aims: 1) To empirically derive physician-hospital networks (PHNs) within SEER-Medicare data for future characterization of prostate cancer treatment patterns and outcomes among the elderly; and 2) to explore the effect of functional status on prostate cancer treatment patterns among the elderly. Study Design: We will use SEER-Medicare to develop primary care and prostate cancer treatment anchored PHNs and then profile PHN attributes hypothesized to be relevant to rates of over and undertreatment (Aim 1). We will use SEER-Medicare Health Outcomes Survey data and incorporate generalized estimating equations to examine patient-reported, geriatric-focused measures before and after prostate cancer treatment (Aim 2). Relevance to National Institute on Aging: Findings from this proposal will address critical barriers to claims- based analyses related to provider accountability/care attribution and to the lack of information on patient- reported measures. The proposal will provide geriatric-focused mentorship and methodological experience, including exposure to PHNs and to functional status measurement. These opportunities will lay the foundation for examining provider factors associated with better treatment targeting and for evaluating the relationship between functional status and prostate cancer treatment decision making.