Understanding optimal delivery systems for cancer care

项目摘要 癌症护理的质量和成本在医院和卫生系统之间差别很大。大号 大量研究表明，结果较好的医院往往有大量病例 以及明确的癌症护理重点。这些数据和其他数据促使许多人倡导 专门的癌症医院--所谓的“重点工厂”--作为治疗癌症的最佳输送系统 实现更高效的癌症护理。然而，《平价医疗法案》中的改革，包括 责任关怀组织(ACO)正在将关怀从这种模式中转移出来。虽然 支持者认为，ACO将通过鼓励以前不一致的方式来提高效率 医院和医生向综合递送系统发展，其他人担心 对于患有复杂癌症诊断的患者，预期的好处不会增加，而ACOS将会 不鼓励转诊到癌症专业知识最强的医院。为了探讨这个问题，我们 提出一项研究，全面评估护理提供模式之间的关系 以及美国癌症护理的质量、结果和成本。在第一个目标中，我们将 检查护理提供模式对癌症护理质量的影响。使用国家 Medicare声明和关联的SEER-Medicare数据，我们将确定乳房患者的队列， 肺癌、前列腺癌和胰腺癌。然后我们将比较所提供的癌症护理的质量 基于对指南建议的遵守程度的不同护理提供模式 和/或国家认可的质量措施。我们假设专注于癌症的医院通常会 有更高水平的依从性，部分原因是他们对特定疾病的集中度更高 专业知识。在第二个目标中，我们将评估护理提供模式和 结果，包括手术死亡率、并发症、住院和长期生存。 我们假设，在癌症专科医院接受治疗的患者死亡率会更高。 结果，而更好的交付系统集成将与更少的住院相关 在最初的癌症治疗之后。在第三个目标中，我们将审查与癌症相关的支出 这些患者在确诊后随着时间的推移而变化。我们还将评估付款情况 与不同的临床服务相关，包括外科手术、系统治疗、临终关怀 护理和非癌症相关治疗。我们期待以癌症为重点的医院将实现 节省了手术护理周期，患者接受了更全面的分娩 该系统将降低癌症治疗的纵向成本。这项研究的结果将 事实证明，在CMS政策制定者和其他利益相关者辩论交付是否 被认为总体上有利于医疗保健的制度改革对癌症患者也是有利的。

Project Summary The quality and cost of cancer care vary widely across hospitals and health systems. A large body of research indicates that hospitals with better outcomes tend to have large case volumes and a defined focus on cancer care. These and other data have prompted many to advocate for specialized cancer hospitals-so-called "focused factories"-as the best delivery system for achieving more efficient cancer care. However, reforms in the Affordable Care Act, including Accountable Care Organizations (ACO), are moving care away from this model. Although proponents argue that ACOs will improve efficiency by encouraging previously unaligned hospitals and physicians to evolve toward integrated delivery systems, others worry that the intended benefits will not accrue for patients with complex cancer diagnoses, and that ACOs will discourage referrals to hospitals with the greatest cancer expertise. To explore this issue, we propose a study that evaluates comprehensively the relationship between care delivery models and the quality, outcomes, and cost of cancer care in the United States. In the first aim, we will examine the impact of care delivery models on the quality of cancer care. Using national Medicare claims and linked SEER-Medicare data, we will identify cohorts of patients with breast, lung, prostate, and pancreatic cancer. We will then compare the quality of cancer care provided in different care delivery models based on levels of adherence with guideline recommendations and/or nationally-endorsed quality measures. We posit that cancer-focused hospitals will often have higher levels of adherence, due in part to their greater concentration of disease-specific expertise. In the second aim, we will assess the association between care delivery models and outcomes, including operative mortality, complications, hospitalizations, and long-term survival. We hypothesize that patients treated in cancer-focused hospitals will have better mortality outcomes, while greater delivery system integration will correlate with fewer hospitalizations following initial cancer therapy. In the third aim, we will examine cancer-related expenditures for these patient cohorts as they vary over time after diagnosis. We will also assess payments related to different clinical services including surgical procedures, systemic therapy, end-of-life care, and non-cancer-related treatments. We expect that cancer-focused hospitals will achieve savings around episodes of surgical care, and that patients treated in more integrated delivery systems will have lower longitudinal costs for their cancer care. Results from this study will prove invaluable to CMS policymakers and other stakeholders as they debate whether delivery system reforms deemed good for healthcare in general are also good for patients with cancer.