Assessing Variation in Outcomes for Cancer Patients Receiving Radiation Treatments and Identifying High-Value Radiation Oncology Practices

项目摘要/摘要 这份NCI K08职业发展建议的总体目标是促进林美兰博士发展成为 肿瘤学卫生政策研究中的独立调查员专注于了解影响 癌症护理的质量和成本。她提出的项目旨在描述放射肿瘤学支出的变化， 整个美国的利用率和质量，并确定高价值放射肿瘤学实践所使用的策略。 主要目标是1)确定和描述放射肿瘤学支出、利用和质量方面的差异 对于接受放射治疗的癌症患者，2)具体调查在支出、利用和治疗方面的差异 放射肿瘤学的质量适用于双重资格的患者，他们在医疗保险中年龄较大，在医疗保险中收入较低或残疾 医疗补助，以及3)阐明高价值实践与低价值实践所使用的方法和策略。综合评价 分析放射肿瘤学实践在花费、使用和质量方面的差异是优化的第一步 美国各地通过放射治疗提供癌症护理服务。确定护理方法和治疗方法的差异 高价值实践与低价值实践遇到的障碍对医生、患者、医院领导和 政策制定者。虽然目前强制性放射肿瘤学替代支付模式(RO APM)由 医疗保险和医疗补助(CMS)被搁置，替代支付和交付模式正在影响肿瘤学。这个项目 将及时为CMS和Practice提供有价值的数据，以调整或通知未来的任何APM，如 在不对癌症护理质量产生负面影响的情况下，确保成功过渡是必要的。即使当前的表单 目前还没有实施RO APM，理解高价值和低价值实践中的差异仍将是 确定某些做法是否需要额外支持以继续为其客户提供高价值的护理，这一点很有价值 癌症患者。 在拟议研究的目标1中，调查者将分析联邦医疗保险索赔数据，以表征 癌症放射治疗患者的费用、利用率和质量。她将有系统地 并全面评估放射肿瘤学实践。在《目标2》中，她将深入研究 符合双重条件的患者的费用、利用率和质量。最后，在《目标3》中，她将对关键线人进行采访 高价值实践和低价值实践的对比，以阐明管理、领导和护理提供方面的差异。

Project Summary/Abstract The overall goal of this NCI K08 career development proposal is to facilitate Dr. Miranda Lam’s development into an independent investigator in oncology health policy research focused on understanding factors and policies that impact the quality and cost of cancer care. Her proposed project aims to characterize the variation in radiation oncology spending, utilization, and quality across the U.S. and identify strategies used by high-value radiation oncology practices. The primary objectives are to 1) identify and characterize variation in radiation oncology spending, utilization, and quality for cancer patients undergoing radiation therapy, 2) specifically investigate whether disparities in spending, utilization and quality of radiation oncology exist for dual-eligible patients, who are older on Medicare and low-income or disabled on Medicaid, and 3) elucidate approaches and strategies used by high- vs. low-value practices. A comprehensive evaluation and analysis of variation in spending, utilization, and quality of radiation oncology practices is the first step to optimizing cancer care delivery with radiation treatments across the U.S. Identifying the differences in approaches to care and barriers encountered by high- vs low-value practices are critically important for physicians, patients, hospital leaders, and policymakers. While the current mandatory Radiation Oncology Alternative Payment Model (RO APM) by Centers for Medicare and Medicaid (CMS) is on hold, alternative payment and delivery models are impacting oncology. This project will be timely and provide CMS and practices with valuable data to adjust or inform any future APMs in the future, as necessary to ensure successful transition without negatively impacting the quality of cancer care. Even if the current form of the RO APM is not implemented at this time, understanding variation in high- and low-value practices will still be valuable to determine whether certain practices need additional support to continue to provide high-value care for their cancer patients. In Aim 1 of the proposed study, the investigator will analyze Medicare claims data to characterize the variation in spending, utilization, and quality for patients undergoing radiation therapy for cancer treatments. She will systematically and comprehensively evaluate radiation oncology practices. In Aim 2, she will delve into whether there are differences in spending, utilization, and quality for dual-eligible patients. Finally, in Aim 3, she will perform key informant interviews of high- and low-value practices to elucidate differences in management, leadership, and care delivery.