The cost of illness: The impact of COVID-19 on patient financial outcomes

项目总结/摘要 候选人：诺拉贝克尔，医学博士，博士，是一个初级保健医生，卫生经济学家，和早期的职业健康 服务研究员。她的长期职业目标是成为一名独立的医生调查员， 疾病对妇女和弱势群体财务状况影响问题国家专家， 为政策提供信息，以减少差异，保护患者免受经济损失。 研究背景：疾病的经济后果-被称为“财务毒性”-是重要的病人 结果。财务毒性包括客观财务负担和主观财务困境两个方面， 但由于缺乏可用数据，很难衡量客观的财务负担。此外，现有的 主观财务困境的衡量标准是有限的和异质的。SARS-CoV-2（COVID-19） 大流行使得开发新的方法来估计和了解 急性疾病后的财务毒性。 具体目标：1）确定COVID-19后客观经济负担风险最高的患者亚组 2）估计COVID-19感染对客观经济负担的因果影响，独立于 大流行期间的经济趋势，并按患者亚组描述结局的异质性; 3）评估 与COVID-19感染相关的主观财务困境。 研究计划：在目标1和2中，Becker博士将对商业信用报告数据进行新的数据链接， 密歇根州蓝十字蓝盾（BCBSM）保险索赔，以及邮政编码水平的社会决定因素 健康在目标1中，她将使用机器学习方法来识别哪些患者的贫困风险最高。 在目标2中，她将使用先进的计量经济学方法， 估计COVID-19感染对信用报告结果的影响，独立于整体经济趋势 在大流行期间，并按患者亚组描述结局的异质性。在目标3中，贝克尔博士将 调整、试行和管理一项新的针对COVID-19的主观财务困境调查措施。 这些目标将综合评估COVID-19感染的财务毒性。 职业发展计划：贝克尔博士将发展1）机器学习方法，2）新的 发展了先进的计量经济学方法，3）主要的数据收集和调查方法，4）领导 和沟通技巧，以有效地传播她的工作，为政策变化提供信息。贝克医生的训练 得到密切的指导，先进的教学课程，参与职业发展的支持 活动，并与媒体和政策制定者分享她的研究成果。 研究目标：本研究的目标是确定COVID-19感染的财务影响， 患者在感染后最有可能遭受经济损失， 经济结果的差异，更好地保护病人免受疾病的经济后果。

PROJECT SUMMARY/ABSTRACT Candidate: Nora Becker, MD, PhD, is a primary care physician, health economist, and early career health services researcher. Her long-term career objective is to become an independent physician-investigator and national expert on the impact of illness on financial outcomes for women and vulnerable populations in order to inform policies to reduce disparities and protect patients from financial harm. Research Context: The financial consequences of illness—termed “financial toxicity”—are important patient outcomes. Financial toxicity has two components, objective financial burden and subjective financial distress, but the lack of available data has made it difficult to measure objective financial burden. Further, the existing measures of subjective financial distress are limited and heterogeneous. The SARS-CoV-2 (COVID-19) pandemic has made it even more important to develop new ways to estimate and understand the magnitude of financial toxicity following acute illness. Specific Aims: 1) Identify patient subgroups at highest risk for objective financial burden after COVID-19 infection; 2) Estimate the causal effect of COVID-19 infection on objective financial burden independent of economic trends during the pandemic and describe heterogeneity in outcomes by patient subgroup; 3) Assess subjective financial distress related to COVID-19 infection. Research Plan: In Aims 1 and 2, Dr. Becker will perform a novel data linkage of commercial credit report data, Blue Cross Blue Shield of Michigan (BCBSM) insurance claims, and zip code-level social determinants of health. In Aim 1 she will use machine learning methods to identify which patients are at highest risk of poor credit report outcomes after COVID-19 infection, and in Aim 2 she will use advanced econometric methods to estimate the effect of COVID-19 infection on credit report outcomes, independent of overall economic trends during the pandemic, and describe heterogeneity in outcomes by patient subgroups. In Aim 3, Dr. Becker will adapt, pilot, and administer a new COVID-19-specific survey measure of subjective financial distress. Together, these aims will comprehensively estimate the financial toxicity of COVID-19 infection. Career Development Plan: Dr. Becker will develop expertise in 1) machine learning methods, 2) newly developed advanced econometric methods, 3) primary data collection and survey methods, and 4) leadership and communication skills to disseminate her work effectively to inform policy change. Dr. Becker's training will be supported by close mentorship, advanced didactic coursework, participation in career development activities, and engagement with media and policymakers to share the results of her research. Research Goals: The goal of this research is to identify the financial effects of COVID-19 infection, and which patients are most at risk of financial harm following infection, to inform the development of policies to reduce disparities in financial outcomes and better protect patients from the financial consequences of illness.