Managed Care Penetration and Cancer Care

管理式医疗渗透率和癌症护理

• 批准号: 6522903
• 负责人: EDWARD GUADAGNOLI
• 金额: $ 37.06万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6522903
• 关键词: breast neoplasms; cancer rehabilitation /care; colorectal neoplasms; combination cancer therapy; health care cost /financing; health care quality; health care service utilization; human data; mammography; managed care; neoplasm /cancer diagnosis; neoplasm /cancer therapy; prostate neoplasms; prostate specific antigen

Recent evidence suggests that as the market share of managed care increases, expenditures in the fee-for-service sector decrease. This observation demonstrates managed care's extensive effect on the entire health care system and is referred to as a "spillover" effect. It is not known; however, whether quality of care in the fee-for-service sector varies as function of managed care penetration. If lower expenditures in markets with higher penetration result from reductions in the provision of needed services, quality of care in these markets will either decline or improve at a slower rate than in other markets. We propose to examine whether managed care penetration is associated with the quality of care and choice of treatments provided to Medicare patients diagnosed with breast, colorectal, or prostate cancer. We will (1) examine the association between managed care penetration and the quality of care (annual mammography following initial therapy for women diagnosed with early-stage breast cancer; adjuvant chemotherapy for patients diagnosed with stage III colon cancer; adjuvant chemotherapy and radiation therapy for patients diagnosed with stage II or III rectal cancer; recommended surveillance activities (for example, colonoscopy within one year of diagnosis) for patients diagnosed with colorectal cancer; and PSA testing within one year of diagnosis for men diagnosed with localized prostate cancer; (2) examine the association between managed care penetration and the use of treatments that are equally effective but that differ in cost for breast cancer (mastectomy versus breast conserving surgery) and prostate cancer (conservative management versus surgery or radiation therapy); and (3) examine mechanisms by which changes in managed care penetration may lead to changes in patterns of care. That is, whether the influence of managed care on the provider specialty composition within a market and on the availability of technologies within a market will partially explain variations in care associated with changes in managed care penetration. We will use SEER-Medicare data to identify patients diagnosed between 1992 and 1996. We will obtain data from the Health Care Financing Administration and from InterStudy to construct measures of managed care penetration at the county, Health Care Resource Area, and Metropolitan Statistical Area level. We will conduct our analyses within each of these levels using hierarchical regression models. Efforts to reduce cancer- related morbidity and mortality depend upon the provision of services known to be effective. In cases where one effective treatment has not been identified, quality of life can be improved by providing services that are congruent with patients' preferences. This project seeks to determine whether market forces influence the patterns of cancer care. If managed care penetration is negatively associated with the delivery of care, interventions targeted toward policy-makers, providers, and patients will be needed to counteract the effects of market forces.

最近的证据表明，随着托管护理的市场份额的增加，费用服务部门的支出减少。 该观察结果表明，托管护理对整个医疗保健系统的广泛影响，被称为“溢出”效应。 这是不知道的；但是，费用服务部门的护理质量是否随着托管护理渗透的功能而变化。 如果在提供所需服务的减少导致渗透率较高的市场中的支出较低，那么这些市场的护理质量将比其他市场慢的速度下降或改善。 我们建议检查托管护理渗透是否与诊断为诊断为乳腺癌，结直肠癌或前列腺癌的医疗保险患者提供的护理质量和选择有关。 我们将（1）检查托管护理渗透与护理质量之间的关联（对诊断为早期乳腺癌诊断的妇女的年度乳房X线摄影；针对诊断为III期结肠癌诊断为III期结肠癌的患者的辅助化学疗法；辅助化学疗法和放射治疗，用于患有II或III期直肠癌的患者；例如，诊断为诊断为cluce canceles canceles cluce and nime;，诊断为诊断;在诊断为局部前列腺癌的男性的一年之内；在市场内的提供者专业组成以及市场中的技术可用性上的托管护理将部分解释与托管护理渗透变化相关的护理变化。 我们将使用SEER-MEDICARE数据来确定1992年至1996年之间被诊断出的患者。我们将从医疗保健融资管理局和知识中获取数据，以构建该县，卫生保健资源领域和大都市统计领域水平的托管护理渗透率。 我们将使用分层回归模型在每个级别的每个级别进行分析。 降低癌症相关的发病率和死亡率的努力取决于提供已知有效的服务。 如果尚未确定一种有效的治疗方法，可以通过提供与患者偏爱一致的服务来改善生活质量。 该项目旨在确定市场力量是否影响癌症护理的模式。 如果托管护理渗透与提供护理的交付负相关，则需要针对决策者，提供者和患者的干预措施来抵消市场力量的影响。