Understanding optimal delivery systems for cancer care

描述（由申请人提供）：癌症护理的质量和成本在医院和卫生系统之间差异很大。大量的研究表明，结果更好的医院往往有大量的病例和明确的癌症护理重点。这些数据和其他数据促使许多人提倡建立专门的癌症医院，即所谓的“集中工厂”，作为实现更有效癌症治疗的最佳输送系统。然而，《平价医疗法案》的改革，包括责任医疗组织（ACO），正在使医疗远离这种模式。虽然支持者认为，ACO将通过鼓励以前不结盟的医院和医生向综合交付系统发展来提高效率，但其他人担心，对于患有复杂癌症诊断的患者来说，预期的好处不会增加，并且ACO将阻止转诊到具有最大癌症专业知识的医院。为了探讨这个问题，我们提出了一项研究，全面评估护理模式之间的关系和质量，结果和成本的癌症护理在美国。在第一个目标中，我们将研究护理模式对癌症护理质量的影响。使用国家医疗保险索赔和相关的SEER医疗保险数据，我们将确定乳腺癌，肺癌，前列腺癌和胰腺癌患者的队列。然后，我们将比较癌症护理的质量，提供不同的护理模式的基础上遵守水平与指南的建议和/或国家认可的质量措施。我们认为，以癌症为重点的医院往往会有更高的依从性，部分原因是他们更集中的疾病特异性专业知识。在第二个目标中，我们将评估护理模式与结果之间的关联，包括手术死亡率，并发症，住院和长期生存。我们假设，在以癌症为重点的医院接受治疗的患者将有更好的死亡率结果，而更大的输送系统整合将与初始癌症治疗后更少的住院相关。在第三个目标中，我们将审查与癌症有关的支出， 这些患者队列，因为它们在诊断后随时间变化。我们还将评估与不同临床服务相关的支付，包括外科手术、系统治疗、临终关怀、 护理和非癌症相关治疗。我们预计，以癌症为重点的医院将在手术护理方面实现节省，并且在更集成的交付系统中接受治疗的患者将具有更低的癌症护理纵向成本。这项研究的结果将证明CMS政策制定者和其他利益相关者是非常宝贵的，因为他们正在讨论被认为对医疗保健有益的交付系统改革是否对癌症患者也有好处。

DESCRIPTION (provided by applicant): The quality and cost of cancer care vary widely across hospitals and health systems. A large body of research indicates that hospitals with better outcomes tend to have large case volumes and a defined focus on cancer care. These and other data have prompted many to advocate for specialized cancer hospitals-so-called "focused factories"-as the best delivery system for achieving more efficient cancer care. However, reforms in the Affordable Care Act, including Accountable Care Organizations (ACO), are moving care away from this model. Although proponents argue that ACOs will improve efficiency by encouraging previously unaligned hospitals and physicians to evolve toward integrated delivery systems, others worry that the intended benefits will not accrue for patients with complex cancer diagnoses, and that ACOs will discourage referrals to hospitals with the greatest cancer expertise. To explore this issue, we propose a study that evaluates comprehensively the relationship between care delivery models and the quality, outcomes, and cost of cancer care in the United States. In the first aim, we will examine the impact of care delivery models on the quality of cancer care. Using national Medicare claims and linked SEER-Medicare data, we will identify cohorts of patients with breast, lung, prostate, and pancreatic cancer. We will then compare the quality of cancer care provided in different care delivery models based on levels of adherence with guideline recommendations and/or nationally-endorsed quality measures. We posit that cancer-focused hospitals will often have higher levels of adherence, due in part to their greater concentration of disease-specific expertise. In the second aim, we will assess the association between care delivery models and outcomes, including operative mortality, complications, hospitalizations, and long-term survival. We hypothesize that patients treated in cancer-focused hospitals will have better mortality outcomes, while greater delivery system integration will correlate with fewer hospitalizations following initial cancer therapy. In the third aim, we will examine cancer-related expenditures for these patient cohorts as they vary over time after diagnosis. We will also assess payments related to different clinical services including surgical procedures, systemic therapy, end-of-life care, and non-cancer-related treatments. We expect that cancer-focused hospitals will achieve savings around episodes of surgical care, and that patients treated in more integrated delivery systems will have lower longitudinal costs for their cancer care. Results from this study will prove invaluable to CMS policymakers and other stakeholders as they debate whether delivery system reforms deemed good for healthcare in general are also good for patients with cancer.