Understanding Racial Disparities in Cancer Surgery

了解癌症手术中的种族差异

• 批准号: 7191942
• 负责人: John D Birkmeyer
• 金额: $ 13.16万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-14 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7191942
• 关键词: Adjuvant Therapy; Adopted; Beds; Bladder; Breast; Caring; Characteristics; Clinical; Clinical Data; Colorectal; Colorectal Cancer; Databases; Depth; Diagnosis; Excision; Hand; Health; Health Services Research; Healthcare Systems; High-Risk Cancer; Hospitals; Individual; Inpatients; Instruction; Intervention; Link; Lung; Malignant Neoplasms; Medicare; Mentors; Michigan; Minority; Modeling; Morbidity - disease rate; National Comprehensive Cancer Network; Numbers; Nurses; Operative Surgical Procedures; Other Resources; Outcome; Outpatients; Patients; Phase; Physicians; Policies; Population; Private Sector; Procedures; Process; Proxy; Quality of Care; Race; Rate; Recurrence; Research; Research Personnel; Risk; Scientist; Screening procedure; Specialist; Staging; Structure; Surgeon; Survival Rate; System; Technology; Variant; Work; base; cancer surgery; care seeking; design; experience; improved; insight; interest; mortality; network models; prospective; skills

DESCRIPTION (provided by applicant): Racial disparities in outcomes after cancer surgery are becoming increasingly apparent. Black patients have both increased risks of operative mortality and lower 5-year survival rates. This project will pursue the Hypothesis that these disparities primarily reflect the suboptimal health care systems in which black patients tend to receive their care. In exploring hospital-level differences in quality of care, we have 3 specific aims: Aim I. To explore racial disparities in the structure and process of care with cancer surgery - Using both national Medicare database (2000-4) and linked SEER-Medicare files (1995-2004), we plan to study structure and process of care variables potentially related to both race and surgical quality in patients with lung, breast, and colorectal cancer. Aim II. To identify which factors help explain racial disparities in surgical outcomes - Using hierarchical models, we will assess the extent to which racial disparities in surgical outcomes are explained by differences in specific structural factors and processes of care (from Aim 1). Aim III. To delve deeper into structure and process with clinical data - To add clinical "granularity" to our research, we will repeat Aims 1 and 2 using prospective clinical data from the Michigan Surgical Quality Collaborative, which involves 17 of the largest hospitals in Michigan (including several with predominantly minority populations). This project will serve as a platform for mentoring several surgeon scientists interested in quality of care issues and racial disparities in bladder, breast, colorectal, and other cancers. With mentored research opportunities and further instruction in health services research, these junior investigators will acquire the skills necessary to develop clinically-oriented research agendas exploring quality of care problems in their fields. They will also acquire insights necessary to develop and evaluate interventions aimed at reducing racial disparities.

描述（由申请人提供）：癌症手术后结果的种族差异变得越来越明显。黑人患者的手术死亡率风险增加，较低的5年生存率。该项目将提出这样的假设：这些差异主要反映了黑人患者倾向于接受护理的次优医疗保健系统。在探索医院级别的护理质量差异时，我们有3个具体目标： 目的I.使用国家医疗保险数据库（2000-4）和Linked Seer-Medicare Files（1995-2004）探索癌症手术结构和护理过程中的种族差异，我们计划研究患有肺，乳房和结肠癌患者种族和手术质量的护理变量的结构和护理变量的结构和过程。 目标II。为了确定哪些因素有助于解释手术结果中的种族差异 - 使用分层模型，我们将评估手术结果中的种族差异在多大程度上通过特定结构因素和护理过程的差异来解释（来自AIM 1）。 目标三。为了深入研究临床数据的结构和过程 - 为了在我们的研究中添加临床“粒度”，我们将使用来自密歇根州手术质量合作的前瞻性临床数据重复目标1和2，这涉及密歇根州最大的17家医院（包括一些主要少数人口的医院）。 该项目将成为指导几位对膀胱，乳房，结直肠癌和其他癌症的医疗质量和种族差异感兴趣的外科医生科学家的平台。借助指导的研究机会和卫生服务研究的进一步指导，这些初级研究人员将获得开发临床上的研究议程所需的技能，以探索其领域的护理问题。他们还将获得开发和评估旨在减少种族差异的干预措施所需的见解。