Impact of Urologist Practice Structure on Prostate Cancer Care

描述（由申请人提供）：前列腺癌是一种常见且昂贵的疾病，每年花费超过120亿美元。在过去的十年中，前列腺癌的支出每年增加11%，超过了其他常见疾病如心血管和肺部疾病的增长率。这一增长部分是由于泌尿科医生自我推荐诊断和治疗服务所提供的经济激励。近年来，大型泌尿外科团体的激增有可能进一步扩大这些趋势。这些大型集团的形成得益于其独特的投资机会，例如拥有提供调强放射治疗和横截面成像的昂贵设备的所有权。然而，支持者认为，他们的“一站式”模式为前列腺癌患者提供了更好的护理整合，最终以更低的成本获得更好的质量。因此，在本发明中， 这项全国性研究的目的是更好地了解泌尿科医师执业组织与前列腺癌护理的数量、质量和成本之间的关系。为了更仔细地研究这一问题，这笔赠款有以下三个目标。目标1。评估泌尿科医师执业组织与前列腺癌利用之间的关系。使用国家医疗保险和SEER医疗保险数据，我们将衡量前列腺癌的检测和治疗是如何介导的泌尿科医生组的做法结构。目标2.测量泌尿科医师执业组织与前列腺癌护理质量之间的关系。使用类似的方法，我们将确定泌尿科医生的实践结构对前列腺癌护理质量的影响，包括遵守国家认可的标准和过度使用的广度。目标3。评估泌尿科医师执业组织与前列腺癌费用之间的关系。我们将衡量泌尿科医生的执业结构和国家医疗保险支付之间的关联，无论是人均（即，平均总支出）和围绕局部治疗的每一次发作。这一建议对所有前列腺癌利益相关者都有现实意义。首先，我们的研究结果与质量有直接的影响，病人，谁是逻辑上感兴趣的机制，提高前列腺护理的质量。其次，了解前列腺癌护理的相对效率对支付者和政策制定者来说是直接利益，因为他们正在探索提高质量的策略，同时限制不必要的支出增长。

DESCRIPTION (provided by applicant): Prostate cancer is a common and expensive disease with annual spending topping $12 billion. During the past decade, prostate cancer spending has increased by 11% annually, outpacing growth rates for other common conditions such as cardiovascular and pulmonary diseases. This growth is due, in part, to financial incentives afforded by urologist self-referral of diagnostic and therapeutic services. The recent proliferatio of large urology groups has the potential to further amplify these trends. The formation of these large groups has been propagated by their unique investment opportunities, such as ownership interests in expensive equipment to provide intensity modulated radiation therapy and cross-sectional imaging. However, proponents argue that their "one-stop" model results in better care integration for men with prostate cancer, ultimately yielding better quality at a lower cost. Thus, the goal of this national study is to better understand relationships between urologist practice organization and the quantity, quality and cost of prostate cancer care. To examine this issue more carefully, this grant has the following three aims. Aim 1. To assess relationships between urologist practice organization and prostate cancer utilization. Using national Medicare and SEER-Medicare data, we will measure how prostate cancer detection and treatment are mediated by urologist group practice structure. Aim 2. To measure relationships between urologist practice organization and the quality of prostate cancer care. Using similar methods, we will determine the effect of urologist practice structure on the quality of prostate cancer care including adherence to nationally endorsed standards and the breadth of overuse. Aim 3. To assess relationships between urologist practice organization and prostate cancer expenditures. We will measure the association between urologist practice structure and national Medicare payments, both per capita (i.e., average overall spending) and per episode surrounding local treatment. This proposal has real-world implications for all prostate cancer stakeholders. First, our findings with respect to quality have immediate implications for patients, who are logically interested in mechanisms for improving the quality of prostate care delivered. Second, understanding the relative efficiency of prostate cancer care is of immediate interest to payers and policymakers as they explore strategies to improve quality while limiting unnecessary spending growth.