Health System Factors and Patient Outcomes in Breast Cancer

描述(由申请者提供)：来自整个癌症社区的利益相关者强调了与交付系统结构和过程相关的研究的必要性，以便为提高护理质量的倡议提供信息。尽管对信息的需求日益增长，但关于癌症护理提供的实践特征和过程的差异如何影响相关患者结局的严谨研究很少。拟议的竞争性继续研究的具体目标是：1)通过自行邮寄调查(或电话调查选项)，收集底特律SEER登记处最近诊断为乳腺癌的1800名女性患者及其主治医生和肿瘤学家的人口样本的信息。SEER登记处的社会人口学和临床数据将补充患者调查信息；2)描述我们样本中的临床医生在关键输送系统流程指标以及医生和执业特征指标中报告的差异。交付系统流程措施评估临床信息的可用性、提供者团队设计、患者决策和护理支持以及实践管理支持。医生的特征包括年龄、性别、种族、执业年数和乳腺癌相关执业的数量。实践特征包括付款人组合、大学隶属关系、教学计划状态、实践规模、癌症计划状态和实践资源；3)检查三个患者结果与交付系统过程测量分数的关系。患者的结果包括：1)对护理过程的决策和评估的满意度；2)手术和非手术治疗的利用；3)与健康相关的生活质量；以及4)检查患者结果与种族或社会人口因素的关联是否因交付系统过程的测量分数而异。拟议研究的结果将为改善社区乳腺癌妇女护理质量的倡议和干预措施提供参考。

DESCRIPTION (provided by applicant): Stakeholders from across the cancer community have stressed the need for research related to delivery system structure and processes to inform initiatives to improve the quality of care. Despite this growing demand for information, little rigorous research exists about how variations in practice characteristics and processes of cancer care delivery affect relevant patient outcomes. The specific aims of the proposed competing continuation study are: 1) To collect information on a population- based sample of 1800 female patients recently diagnosed with breast cancer derived from the Detroit SEER registry and their attending surgeons and oncologists via a self-administered mailed survey (or telephone survey option). Patient survey information will be augmented by sociodemographic and clinical data from the SEER registry; 2) To describe the variations reported by the clinicians in our sample in key delivery system process measures as well as in measures of physician and practice characteristics. The delivery system process measures assess availability of clinical information, provider team design, patient decision and care support, and practice management support. Physician characteristics include age, gender, race, number of years in practice, and volume of breast cancer-related practice. Practice characteristics include payer mix, university affiliation, teaching program status, practice size, cancer program status, and practice resources; 3) To examine the association of three patient outcomes with delivery system process measure scores. Patient outcomes include: 1) satisfaction with decision-making and evaluation of care processes; 2) the utilization of surgical and non-surgical treatments; and 3) health-related quality of life; and 4) To examine whether the association of patient outcomes with race or sociodemographic factors varies across delivery system process measure scores. The results from the proposed study will inform initiatives and interventions to improve the quality of care for women with breast cancer in the community.