COLORECTAL CANCER CARE VARIATION IN VULNERABLE ELDERLY

弱势老年人的结直肠癌护理差异

基本信息

批准号：
6498001
负责人：
Laura-Mae Baldwin
金额：
$ 40.78万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2001
资助国家：
美国
起止时间：
2001-06-04 至 2004-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6498001
关键词：
Medicare /Medicaid cancer registry /resource colorectal neoplasms health care cost /financing health care service health care service evaluation health services research tag human data human old age (65+) neoplasm /cancer chemotherapy neoplasm /cancer radiation therapy racial /ethnic difference rural area urban area

项目摘要

Specific Aims: This study's long-term goal is to improve colorectal cancer care for the elderly who have a high incidence of this highly treatable and potentially curable disease. In 1990, a National Institutes of Health Consensus Panel recommended adjuvant therapies for colorectal cancer patients with stage III colon and stage II and III rectal cancer. The degree to which the elderly, especially traditionally vulnerable groups, are receiving these recommended treatments is unclear. This study will (1) compare the receipt of recommended colorectal cancer treatments between African-American and Hispanic versus white elderly, and rural versus urban elderly; (2) compare diffusion of these treatments from 1992-1996 between our study groups; (3) identify the physician, patient, hospital, and environmental factors that predict differences found in treatment or diffusion; (4) measure treatment cost differences between our study groups, and the cost implications to the Medicare program of providing recommended treatments to all beneficiaries with colorectal cancer; and (5) evaluate several methodologies for cancer research using administrative databases, including different measures of comorbidity and costs. Research Design and Methods: This study will use the linked SEER-Medicare claims database in a retrospective cohort design to examine differences in receipt, diffusion, and cost of recommended colorectal cancer treatments between more and less vulnerable elderly populations. Using stage III colon and stage II and III rectal cancer cases identified in SEER between 1992 and 1996, we will identify different patterns of treatment and alternative measures of the costs for colorectal cancer care with Medicare claims data. Annual study cohorts will be tracked in a comprehensive database using 1991-1998 linked SEER-Medicare, AMA Masterfile, AHA, and Area Resource File data. Physician, hospital, and patient characteristics (including cancer stage and comorbidity) will be linked to the location, size, and socioeconomic profile of places of residence, travel distances to different treatment sites and cancer specialists, service utilization, and allowed charges. In the second phase of the study, we will use multivariate analysis to identify the degree to which physician, patient, hospital and environmental factors predict systematic differences in treatment patterns between our study populations. The cost analysis will include an estimate of the resources required to bring all patients up to the recommended standard of care. Alternate methods of defining comorbidity and costs will be used to evaluate their utility in cancer research.

具体目的：这项研究的长期目标是改善对这种高发病率高的老年人的结直肠癌护理可以治疗且潜在可治愈的疾病。 1990年，一个国立机构健康共识面板建议进行结直肠癌的辅助疗法患有III期结肠以及II期和III期直肠癌的患者。学位老年人，尤其是传统上脆弱的群体，正在接受这些建议的治疗尚不清楚。这项研究将（1）比较接收非裔美国人之间建议的结直肠癌治疗以及西班牙裔与白人老年人，农村与城市老年人；（2）比较从1992 - 1996年间，这些治疗的扩散在我们的研究组之间；（3）确定医师，病人，医院和环境因素预测治疗或扩散中发现的差异；（4）衡量治疗成本我们的研究小组之间的差异以及对Medicare的成本影响向所有受益人提供推荐治疗的计划结直肠癌；（5）评估癌症研究的几种方法使用管理数据库，包括合并症的不同量度和费用。研究设计和方法：本研究将使用链接的Seer-Medicare 在回顾性队列设计中索赔数据库，以检查建议的结直肠癌治疗的收据，扩散和成本在更多和不太脆弱的老年人之间。使用第三阶段结肠和 II和III期直肠癌病例在1992年至1996年之间在SEER中确定我们将确定不同的治疗方式和替代措施 Medicare索赔数据的结直肠癌护理的成本。年度研究使用1991-1998链接的综合数据库中，人群将进行跟踪 Seer-Medicare，AMA MasterFile，AHA和区域资源文件数据。医师，医院和患者特征（包括癌症阶段和合并症）将与位置的位置，规模和社会经济概况有关居住，到不同治疗部位的旅行距离和癌症专家，服务利用，并允许收费。在第二阶段这项研究，我们将使用多元分析来确定医师，患者，医院和环境因素预测系统的我们的研究人群之间的治疗模式差异。费用分析将包括对带来所有资源所需的资源的估计患者达到建议的护理标准。定义的替代方法合并症和成本将用于评估其在癌症中的效用研究。