Claims-based measures of care coordination and long-term health among older women with endometrial cancer

摘要 到2030年，有子宫内膜癌病史的美国妇女人数预计将超过1 百万美元。老年子宫内膜幸存者的护理需求不仅包括定期随访以检测 癌症复发，也是预防和管理其他非癌症疾病的内科条件。 考虑到肥胖作为共同风险的作用，心血管疾病(CVD)可能尤其令人担忧 子宫内膜癌和心血管疾病的致病因素。对非癌症疾病的护理以及一般预防 癌症治疗的副作用的护理和管理，可能需要初级保健的参与 医生或其他专家，以及妇科医生和/或妇科肿瘤学家 进行推荐的后续检查以检测子宫内膜癌复发，但可能没有 管理其他医疗条件的专业知识。由此产生的医疗保健需求的复杂性 子宫内膜癌幸存者可能会导致护理的碎片化，护理质量不佳，最终， 健康状况更差。改善对心血管疾病和其他慢性疾病的监测和管理的战略 生存期间的条件，同时也确保妇女得到建议的后续访问 特定于他们的癌症病史，需要支持子宫内膜癌的复杂健康需求 幸存者。 护理协调是指在参与的两个或多个提供者之间组织患者护理活动的努力 为患者的护理提供便利，适当提供医疗保健服务。护理协调措施， 已经开发出通过连接医生和普通患者来共享患者网络的哪种模式 使用管理索赔数据，并已被验证为准确表示提供商的一种手段 沟通模式。我们建议利用监测、流行病学和最终结果(SEER)- Medicare链接数据资源，用于检查基于索赔的护理协调措施之间的关联 以及子宫内膜癌后的长期健康结果。具体来说，我们将评估更高的学位是否 子宫内膜癌确诊后1-3年的护理协调预示着对 指南推荐的用于检测子宫内膜癌复发、降低心血管风险的随访 确诊、住院和急诊科就诊的风险较低，以及总体存活率较高。这 研究将为寻求促进子宫内膜交付的有针对性的干预措施的发展提供信息 癌症存活者护理和改善患者预后。

Abstract By the year 2030, the number of U.S. women with an endometrial cancer history is expected to exceed 1 million. The care needs of older endometrial survivors include not only regular follow-up visits for detection of cancer recurrence, but also the prevention and management of other non-cancer medical conditions. Cardiovascular disease (CVD) may be of especially critical concern, given the role of obesity as a shared risk factor for both endometrial cancer and CVD. Care for non-cancer conditions, as well as general preventive care and management of side effects of cancer treatment, is likely to require the involvement of primary care physicians or other specialists, in addition to the gynecologists and/or gynecologic oncologists who may perform the recommended follow-up exams for detection of endometrial cancer recurrence, but may not have the expertise to manage other medical conditions. The resulting complexity of healthcare needs for endometrial cancer survivors may lead to fragmentation of care, suboptimal care quality, and, ultimately, poorer health outcomes. Strategies to improve surveillance and management of CVD and other chronic conditions during survivorship, while also ensuring that women receive the recommended follow-up visits specific to their cancer history, are needed to support the complex health needs of endometrial cancer survivors. Care coordination refers to efforts to organize patient care activities between two or more providers involved in the patient’s care to facilitate the appropriate delivery of health care services. Measures of care coordination, which model shared patient networks by connecting physicians with common patients, have been developed using administrative claims data, and have been validated as a means of accurately representing provider communication patterns. We propose to utilize the Surveillance, Epidemiology, and End Results (SEER)- Medicare linked data resource to examine associations between claims-based measures of care coordination and long-term health outcomes after endometrial cancer. Specifically, we will assess whether higher degrees of care coordination during years 1-3 after endometrial cancer diagnosis are predictive of greater adherence to guideline-recommended follow-up for detection of endometrial cancer recurrence, lower risk of CVD diagnoses, lower risk of hospitalizations and emergency department visits, and higher overall survival. This research will inform the development of targeted interventions that seek to enhance the delivery of endometrial cancer survivorship care and improve patient outcomes.