Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery

农村医院支付和服务改革对癌症手术地域差异的影响

基本信息

项目摘要

Project Summary Cancer patients in rural areas have more limited access to specialized care, are less likely to receive certain treatments, and have poorer outcomes than their counterparts in non-rural areas. Over recent years, many rural hospitals have closed and a high proportion of remaining rural hospitals are in financial distress and at risk for closure, exacerbating barriers to care for rural patients. At the same time, evidence that the volume of surgeries performed in a hospital is associated with improved health outcomes, including mortality, has led to efforts to regionalize surgical care. Although the advantages of regionalization are well documented, referring cancer surgeries to high-volume centers presents challenges for patients, surgeons, and hospitals in rural communities. Against this complex backdrop, the state of Pennsylvania has initiated the Pennsylvania Rural Health Model (PRHM), an innovative program designed to provide hospitals with predictable revenue streams through global budgets and encourage participating hospitals to redesign care delivery to best meet the needs of their communities. This project will assess the impact of the PRHM on access to and outcomes associated with cancer surgery. First, we will examine the impact of the PRHM on regional cancer surgery delivery patterns by examining the location and characteristics of hospitals at which cancer patients receive surgery using statewide hospital discharge data. By decoupling payment from volume, PRHM changes the incentives for providers to perform surgeries locally versus referring patients to regional centers. We hypothesize that patients in areas served by PRHM hospitals will be more likely to be referred to high-volume centers than those in other rural hospital markets. Second, we will assess the effect of the PRHM on cancer surgery access and outcomes using linked discharge and cancer registry data. The PRHM emphasizes changes in care delivery that target improvements in population health, with a focus on access to specialty care. We hypothesize that surgical cancer patients in areas served by PRHM hospitals may experience improvements in receipt of recommended cancer surgery, time to surgery, and related health outcomes, including mortality and readmissions. Third, we will use qualitative methods to understand the PA Rural Health Model implementation process, including its impacts on resource utilization, hospital capabilities, staffing, care delivery, and financial incentives for providers. We will conduct interviews with key informants and focus groups with community stakeholders. Guided by a comprehensive conceptual model derived from implementation science, we will granularly assess the mechanisms by which PRHM succeeded or failed to affect hospital processes and outcomes for surgical cancer care. As the population in areas served by targeted hospitals continues to age, cancer incidence and the demand for high-quality surgical care will increase. Lessons from this context will be highly relevant for informing alternative payment models in rural hospitals and addressing the needs of surgical cancer patients in rural communities throughout the United States.
项目概要 农村地区的癌症患者获得专门护理的机会更加有限,接受某些治疗的可能性较小 治疗,并且其结果比非农村地区的同行较差。近年来,许多 乡村医院已经关闭,剩余乡村医院很大一部分陷入财务​​困境,处于困境中。 关闭的风险,加剧了农村患者护理的障碍。同时,有证据表明, 在医院进行的手术与改善健康结果(包括死亡率)相关,导致 努力实现外科护理区域化。尽管区域化的优势已有充分记录,但参考 癌症手术转移到高容量中心给农村地区的患者、外科医生和医院带来了挑战 社区。在这种复杂的背景下,宾夕法尼亚州发起了宾夕法尼亚农村计划 健康模式 (PRHM) 是一项创新计划,旨在为医院提供可预测的收入流 通过全球预算并鼓励参与医院重新设计护理服务以最好地满足需求 他们的社区。该项目将评估 PRHM 对获取和相关成果的影响 与癌症手术。首先,我们将研究 PRHM 对区域癌症手术实施的影响 通过检查癌症患者接受手术的医院的位置和特征来确定模式 使用全州范围的出院数据。通过将支付与数量脱钩,PRHM 改变了激励措施 让医疗服务提供者在当地进行手术,而不是将患者转诊至区域中心。我们假设 PRHM 医院服务地区的患者将更有可能被转诊至高容量中心 其他农村医院市场的情况。其次,我们将评估 PRHM 对癌症手术准入的影响 以及使用关联的出院和癌症登记数据的结果。 PRHM 强调护理方面的变化 旨在改善人口健康的服务,重点是获得专业护理。我们 假设 PRHM 医院服务地区的外科癌症患者可能会在以下方面得到改善: 收到建议的癌症手术、手术时间以及相关的健康结果,包括死亡率和 重新入院。第三,我们将使用定性方法来了解PA农村健康模型的实施情况 流程,包括其对资源利用、医院能力、人员配置、护理服务和财务的影响 对供应商的激励。我们将与社区的关键知情人和焦点小组进行访谈 利益相关者。在源自实施科学的综合概念模型的指导下,我们将 详细评估 PRHM 成功或失败影响医院流程的机制, 癌症手术治疗的结果。随着目标医院服务地区的人口持续老龄化, 癌症发病率和对高质量手术护理的需求将会增加。从这一背景中吸取的教训将是 对于告知农村医院的替代支付模式和满足外科手术的需求高度相关 美国各地农村社区的癌症患者。

项目成果

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Lindsay Marie Sabik其他文献

Lindsay Marie Sabik的其他文献

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{{ truncateString('Lindsay Marie Sabik', 18)}}的其他基金

Policies to Inform Safe and Equitable Opioid Access for Patients with Advanced Cancer Near End of Life
为临近生命尽头的晚期癌症患者提供安全和公平的阿片类药物使用政策
  • 批准号:
    10733495
  • 财政年份:
    2023
  • 资助金额:
    $ 61.23万
  • 项目类别:
Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform
保险范围扩大对癌症治疗的影响:最近的政策变化以及对未来改革的影响
  • 批准号:
    10116048
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform
保险范围扩大对癌症治疗的影响:最近的政策变化以及对未来改革的影响
  • 批准号:
    10705053
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery
农村医院支付和服务改革对癌症手术地域差异的影响
  • 批准号:
    10401862
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform
保险范围扩大对癌症治疗的影响:最近的政策变化以及对未来改革的影响
  • 批准号:
    10254333
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform
保险范围扩大对癌症治疗的影响:最近的政策变化以及对未来改革的影响
  • 批准号:
    10474355
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery
农村医院支付和服务改革对癌症手术地域差异的影响
  • 批准号:
    10643700
  • 财政年份:
    2020
  • 资助金额:
    $ 61.23万
  • 项目类别:
Disparities in Cancer Screening: The Role of Medicaid Policy
癌症筛查的差异:医疗补助政策的作用
  • 批准号:
    9064719
  • 财政年份:
    2013
  • 资助金额:
    $ 61.23万
  • 项目类别:
Disparities in Cancer Screening: The Role of Medicaid Policy
癌症筛查的差异:医疗补助政策的作用
  • 批准号:
    8562222
  • 财政年份:
    2013
  • 资助金额:
    $ 61.23万
  • 项目类别:

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