Columbia-GHI Consortium for Claims-Based Cancer Studies

描述(由申请人提供)：在这一探索性/开发性申请中，我们建议创建一个基于索赔的癌症研究中心，作为哥伦比亚大学梅尔曼公共卫生学院和团体健康公司(GHI)之间的联盟。总部位于纽约市的GHI是全州范围内最大的非营利性医疗保险提供商。近300万GHI订户的不同种族和民族构成反映了纽约市-约25%的非裔美国人，28%的拉丁裔和10%的亚裔-使其成为研究癌症差异的宝贵资源。广泛的受抚养人覆盖使我们能够研究配偶和子女。我们的长期目标是利用庞大的用户群作为核心资源，开展癌症筛查和干预、诊断、治疗和结果方面的研究。我们的直接目标是为该中心创建基础设施，并通过实现三个具体目标来展示其有效性。目标1.确定研究中心的范围和结构。执行委员会将提供癌症流行病学、肿瘤学、监测、卫生服务研究和大型数据库技术方面的专业知识，指导相关和可行的研究问题的选择，并为合作和人类主题保护制定指导方针。目标2.我们将通过(目标2a)为监测研究奠定基础：(目标2a)确定GHI用户人口的特征，描述流行病学和社会人口学变量的分布，包括种族/民族、就业状况、年龄、性别和受扶养人(例如配偶、子女)；(目标2b)制定程序，以确定和评估癌症筛查和诊断程序以及索赔数据中的治疗；以及(目标2c)确定将GHI癌症索赔数据与肿瘤登记等外部数据来源联系起来所需的好处和努力。目的3.我们将通过开展三个试点项目来探索GHI Claims数据库对癌症监测、卫生服务和结果研究的有用性：试点A.研究高(乳腺癌、结肠癌)和低(胰腺、食道癌)生存时间的癌症的初始治疗和后续化疗的差异与医院容量、医院的社会经济状况、医生特征和患者的社会经济状况的关系。评估筛查乳腺癌和结肠癌的流行程度与患者的社会经济特征的关系。试点C.创建乳腺癌、结肠癌、前列腺癌和肺癌病例队列，作为调查不同治疗方式的结果、合并症、出院后并发症和存活率以及估计治疗成本的研究资源。

DESCRIPTION (provided by applicant): In this exploratory/developmental application we propose to create a Center for Claims-Based Cancer Research as a consortium between the Mailman School of Public Health at Columbia University and Group Health Incorporated (GHI). New York City-based GHI is the largest statewide not-for-profit health insurance provider. The diverse racial and ethnic makeup of the nearly 3 million GHI subscribers is a reflection of New York City - about 25% African American, 28% Latino, and 10% Asian - making it a valuable resource for studies of cancer disparities. Extensive dependent coverage enables us to study spouses and children. Our long-term goal is to carry out research on cancer screening and interventions, diagnosis, treatment, and outcomes using the large subscriber base as a core resource. Our immediate goal is to create the infrastructure for the center and demonstrate its usefulness by accomplishing three specific aims. Aim 1. Define the scope and structure of the Research Center. An Executive Committee will provide expertise in cancer epidemiology, oncology, surveillance, health services research, and large database technology, guide selection of relevant and feasible research questions, and develop guidelines for collaboration and for human subject protection. Aim 2. We will lay the groundwork for surveillance studies by (Aim 2a): characterizing the GHI subscriber population, describing the distributions of epidemiological and socio-demographic variables including race/ethnicity, employment status, age, gender, and dependency (e.g., spouse, child), (Aim 2b) developing procedures for identifying and assessing cancer screening and diagnostic procedures, and treatments within claims data, and (Aim 2c) determining benefits and effort required for linkage of GHI cancer claims data with external data sources such as tumor registries. Aim 3. We will probe the usefulness for cancer surveillance, health services and outcomes research of the GHI claims database by carrying out three pilot projects: Pilot A. A study of the variation in initial treatment and subsequent chemotherapy for cancers with both high (breast, colon) and low (pancreatic, esophageal) survival times in relation to hospital volume, hospital socioeconomic profile, physician characteristics, and patient socioeconomic status. Pilot B. Estimation of the prevalence of screening examinations for the detection of breast and colon cancer in relation to patient socioeconomic characteristics. Pilot C. Creation of a cohort of incident cases of breast, colon, prostate, and lung cancer, as a research resource for investigating outcomes of different treatment modalities, comorbidity, post-discharge complications, and survival, as well as estimation of treatment costs.