Geospatial drivers of cancer care disparities and their susceptibility to health policy changes

项目摘要 缺乏保险覆盖范围和个人收入与以下方面的巨大差距有关 对实体器官恶性肿瘤患者的癌症护理，包括出现时的晚期疾病， 减少接受癌症指导手术的可能性，并降低存活率。然而，更少的是 了解影响获得和接受护理的上游地理空间健康决定因素 居住在农村社区的20%的美国人。此外，最近的卫生政策在多大程度上 变化影响了对生活在农村和社会经济脆弱的患者的癌症护理服务 社区情况仍不明朗。为了解决这些差距，勒勒博士计划进行一项基于人口的 观察性和准实验性队列研究，以评估农村住宅、社区和社区的影响 水平社会经济剥夺，以及它们与保险范围的相互作用 实体器官恶性肿瘤的治疗。此外，我们将评估平价医疗在多大程度上 ACT相关保险扩大影响了农村和社会经济领域的癌症护理服务 多样化的社区。这项研究利用了精选的州癌症登记的新用途 在地理上相互关联的社区一级社会经济贫困的衡量标准。多水平定量 方法、地理可视化、地理计算方法、时空分析和计量经济学 建模将全部用于描述和可视化保险覆盖面、农村 居住地、地方社区层面的社会经济因素除了决定国家层面的影响 扩大对癌症护理提供方面的差距的保险。这项研究将为以下方面提供重要信息 癌症护理差异的上游地理空间驱动因素，同时也评估 关于农村癌症差异的卫生政策。 勒勒博士是达特茅斯-希区柯克医疗中心的外科肿瘤学家和卫生服务研究员， 达特茅斯卫生政策和临床实践研究所。他的临床实践包括护理病人。 皮肤、软组织和肝脏恶性肿瘤，而他的学术重点是健康政策，社会 健康的决定因素，以及癌症护理提供的公平性。他的长期职业目标是成为一名 创新和独立资助的卫生政策研究人员，重点关注弱势群体。这个 提出的研究计划是对职业发展和培训计划的补充，重点是 地理空间方法和应用。该奖项将为以下工作奠定方法和政策基础 关于各州在医疗补助提供方面的具体豁免的后续研究，目前还为时过早。

Project Summary Lack of insurance coverage and individual income have been associated with considerable disparities in cancer care for patients with solid organ malignancies, including later stage disease at time of presentation, decreased probability of undergoing cancer-directed surgery, and decreased survival. However, much less is understood about upstream geospatial determinants of health that influence access to and receipt of care for the 20% of Americans that live in rural communities. Furthermore, the degree to which recent health policy changes have impacted cancer care delivery for patients living in rural and socioeconomically vulnerable communities remains unclear. To address these gaps, Dr. Loehrer plans to conduct a population-based observational and quasi-experimental cohort study to evaluate the influence of rural residence, community- level socioeconomic deprivation, and their interaction with insurance coverage on presentation with and management of solid organ malignancies. Additionally, we will evaluate the degree to which Affordable Care Act associated insurance expansion influenced cancer care delivery across rural and socioeconomically diverse communities. The study capitalizes on the novel use of select state cancer registries with geographically linked measures of community-level socioeconomic deprivation. Multilevel quantitative methods, geovisualization, geocomputational approaches, spatiotemporal analyses, and econometric modelling will all be used to describe and visualize complex relationships between insurance coverage, rural residence, local community-level socioeconomic factors in addition to determining the influence of state-level insurance expansion on disparities in cancer care delivery. The study will provide important information on upstream geospatial drivers of cancer care disparities while also evaluating the heterogeneous influence of health policy on rural cancer disparities. Dr. Loehrer is a surgical oncologist and health services researcher at Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice. His clinical practice includes care for patients with skin, soft-tissue, and liver malignancies while his academic focus is at the intersection health policy, social determinants of health, and equity of cancer care delivery. His long-term career goal is to become an innovative and independently funded health policy researcher with a focus on vulnerable populations. The research plan presented complements both career development and training plans that are focused on geospatial methodologies and application. The award will lay the methodological and policy foundation for follow-up studies on state-specific waivers in Medicaid delivery that are too early to be evaluated at present.