Cancer Care Delivery in Medicaid

描述（由申请人提供）：癌症治疗的缺陷不成比例地影响少数群体成员，并导致癌症死亡率的种族和民族差异。近1500万美国成年人接受医疗补助，其中许多是黑人或西班牙裔，因此，在这些州健康保险计划的背景下评估癌症护理服务是确定差异来源的合理策略。通过将医疗补助登记和索赔档案与来自纽约州和加利福尼亚州的肿瘤登记数据合并，我们试图确定获得安全网健康保险和种族/民族与常见癌症诊断之间的关系。这两个州拥有大量不同种族的人口和许多医疗补助参保者。我们要解决的首要问题是：哪里有机会减轻穷人的癌症负担？医疗补助中的癌症治疗是否达到了合理的质量基准？在医疗补助计划中，治疗中的种族差异是否仍然存在？具体来说，我们将根据我们团队之前使用医疗保险注册相关数据的工作来评估我们很了解的护理方面：1)诊断阶段分布，癌症严重程度和获得医疗护理的标志；2)癌症手术和在经验丰富、手术量大的医院接受复杂手术；3)癌症的辅助放疗和化疗，这些干预措施可以改善预后。分析将集中在两组医疗补助计划参保者中常见的实体瘤：21-64岁的成年人和65岁以上的老年人，他们都参加了医疗保险。我们将评估医疗补助患者的护理模式，并在数据允许的情况下，将其与医疗补助未涵盖的其他类似人群的模式进行比较。具体来说，对于癌症治疗的每个重要方面，我们还将衡量医疗补助计划中的种族/民族差异，并验证我们的假设，即在诊断前长期登记的患者中，种族/民族差异最小。更一般地说，该项目将为卫生服务研究人员构建一个资源，表征其产量，并使用它来确定和优先考虑特定的机会，以改善弱势美国人的癌症护理服务。公共卫生相关性：癌症治疗并没有达到所有美国人应有的水平。众所周知，对于穷人来说，医疗服务是次优的，他们中的许多人都参加了国家医疗补助计划的保险。这项研究提出了一个问题，对于那些从国家医疗补助计划中获得医疗保险的患者来说，癌症治疗是否像应有的那样好？长期获得医疗补助的患者是否患有晚期疾病？他们是否接受了必要的治疗？在医疗补助计划中是否存在基于种族和民族的护理差距？医疗补助申请中记录的信息是否足够可靠，足以确定癌症治疗的重要方面，如手术、放疗和化疗？医疗补助登记和/或索赔数据与癌症登记数据的联系能否为持续监测护理质量提供一个框架？通过检查来自纽约和加利福尼亚的数据，这两个州有大量的多种族人口和许多生活在贫困中的人，本研究将回答这些问题，并确定改善向贫困美国人提供癌症护理的机会。

DESCRIPTION (provided by applicant): Shortcomings in cancer care disproportionately affect minority group members and contribute to racial and ethnic disparities in cancer mortality. Many of the nearly 15 million US adults insured by Medicaid are Black or Hispanic and therefore, evaluating cancer care delivery in the context of these state health insurance programs is a logical strategy to identify the sources of disparities. By merging Medicaid enrollment and claims files with tumor registry data from New York and California, 2 states with large ethnically diverse populations and many Medicaid enrollees, we seek to identify how access to safety net health insurance and race/ethnicity intersect with common cancer diagnoses. The overarching questions we will address are: Where are there opportunities for decreasing the cancer burden for the poor? Does cancer care delivery in Medicaid achieve reasonable quality benchmarks? Do racial disparities in treatment persist within Medicaid? Specifically, we will evaluate aspects of care we understand well based on our team's prior work using Medicare-registry linked data: 1) Stage distribution at diagnosis, a marker for cancer severity and access to medical care; 2) Cancer surgery and the receipt of complex operations at experienced hospitals with high procedure volume; and, 3) Adjuvant radiation and chemotherapy treatments for cancers where these interventions improve outcomes. Analyses will focus on common solid tumors among two groups of Medicaid enrollees: adults aged 21-64 and the elderly aged 65+ dually enrolled in Medicare. We will evaluate care patterns for Medicaid patients and where data permit, compare them to patterns for otherwise similar persons not covered by Medicaid. Specifically, for each important aspect of cancer care we will also measure racial/ethnic disparities within the Medicaid program and test our hypothesis that they are minimized for patients with long term enrollment prior to diagnosis. More generally, this project will construct a resource for health services researchers, characterize its yield, and use it to identify and prioritize specific opportunities to improve cancer care delivery for vulnerable Americans. PUBLIC HEALTH RELEVANCE: Cancer care is not as good as it should be for all Americans. It is well known that care is sub-optimal for persons who are poor, many of whom are insured by State Medicaid programs. This study asks the question, is cancer care as good as it should be for patients who receive their health insurance from state Medicaid programs? Do patients who have long term access to Medicaid present with more advanced stage disease? Do they receive necessary treatments? Do the gaps in care on the basis of race and ethnicity exist within the Medicaid program? Is the information recorded on Medicaid claims reliable enough to identify important aspects of cancer treatment like surgery, radiation and chemotherapy? Could linkage of Medicaid enrollment and/or claims data to cancer registry data provide a framework for ongoing monitoring of quality of care? By examining data from New York and California which have large multiethnic populations and many persons living in poverty, this study will answer these questions and identify opportunities to improve cancer care delivery to poor Americans.