Cancer Care Delivery in Medicaid

医疗补助中的癌症护理服务

基本信息

批准号：
7526764
负责人：
Deborah Schrag
金额：
$ 47.39万
依托单位：
DANA-FARBER CANCER INST
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-31 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7526764
关键词：
Accounting Address Adjuvant Adjuvant Chemotherapy Adult Affect Age American Benchmarking Breast Caliber California Cancer Burden Cancer Intervention Cancer Patient Caring Cervix Uteri Colon Communities Comorbidity Complex Data Data Linkages Diagnosis Diagnostic Neoplasm Staging Disadvantaged Disease Effectiveness Elderly Eligibility Determination Enrollment Esophageal Ethnic Origin Gender Genus Cola Health Insurance Health Services Health Services Accessibility Hispanics Hospitals Insurance Life Link Liver Malignant Neoplasms Measures Medicaid Medical Medical Surveillance Medicare Medicare/Medicaid Metric Minority Groups Monitor New York Operative Surgical Procedures Outcome Pancreas Patients Pattern Patterns of Care Performance Personal Satisfaction Persons Population Population Heterogeneity Poverty Procedures Public Health Quality of Care Race Radiation Radiosurgery Rate Registries Research Personnel Resources Severities Solid Neoplasm Source Stage at Diagnosis Staging Standards of Weights and Measures Sum Testing Variant Work aged base beneficiary cancer care cancer diagnosis cancer surgery cancer therapy care delivery chemotherapy cohort experience improved member mortality neoplasm registry programs racial and ethnic disparities safety net social tumor

项目摘要

DESCRIPTION (provided by applicant): Shortcomings in cancer care disproportionately affect minority group members and contribute to racial and ethnic disparities in cancer mortality. Many of the nearly 15 million US adults insured by Medicaid are Black or Hispanic and therefore, evaluating cancer care delivery in the context of these state health insurance programs is a logical strategy to identify the sources of disparities. By merging Medicaid enrollment and claims files with tumor registry data from New York and California, 2 states with large ethnically diverse populations and many Medicaid enrollees, we seek to identify how access to safety net health insurance and race/ethnicity intersect with common cancer diagnoses. The overarching questions we will address are: Where are there opportunities for decreasing the cancer burden for the poor? Does cancer care delivery in Medicaid achieve reasonable quality benchmarks? Do racial disparities in treatment persist within Medicaid? Specifically, we will evaluate aspects of care we understand well based on our team's prior work using Medicare-registry linked data: 1) Stage distribution at diagnosis, a marker for cancer severity and access to medical care; 2) Cancer surgery and the receipt of complex operations at experienced hospitals with high procedure volume; and, 3) Adjuvant radiation and chemotherapy treatments for cancers where these interventions improve outcomes. Analyses will focus on common solid tumors among two groups of Medicaid enrollees: adults aged 21-64 and the elderly aged 65+ dually enrolled in Medicare. We will evaluate care patterns for Medicaid patients and where data permit, compare them to patterns for otherwise similar persons not covered by Medicaid. Specifically, for each important aspect of cancer care we will also measure racial/ethnic disparities within the Medicaid program and test our hypothesis that they are minimized for patients with long term enrollment prior to diagnosis. More generally, this project will construct a resource for health services researchers, characterize its yield, and use it to identify and prioritize specific opportunities to improve cancer care delivery for vulnerable Americans. PUBLIC HEALTH RELEVANCE: Cancer care is not as good as it should be for all Americans. It is well known that care is sub-optimal for persons who are poor, many of whom are insured by State Medicaid programs. This study asks the question, is cancer care as good as it should be for patients who receive their health insurance from state Medicaid programs? Do patients who have long term access to Medicaid present with more advanced stage disease? Do they receive necessary treatments? Do the gaps in care on the basis of race and ethnicity exist within the Medicaid program? Is the information recorded on Medicaid claims reliable enough to identify important aspects of cancer treatment like surgery, radiation and chemotherapy? Could linkage of Medicaid enrollment and/or claims data to cancer registry data provide a framework for ongoing monitoring of quality of care? By examining data from New York and California which have large multiethnic populations and many persons living in poverty, this study will answer these questions and identify opportunities to improve cancer care delivery to poor Americans.

描述（由申请人提供）：癌症护理中的缺点不成比例地影响少数群体成员，并导致癌症死亡率的种族和种族差异。在医疗补助保险的近1500万美国成年人中，许多人都是黑人或西班牙裔，因此，在这些州健康保险计划的背景下，评估癌症护理的交付是确定差异来源的逻辑策略。通过将医疗补助注册和索赔文件与来自纽约和加利福尼亚州的肿瘤注册中心数据合并，有2个种族多样性和许多医疗补助参与者的州，我们试图确定如何获得安全网健康保险和种族/种族/种族/种族与常见癌症诊断相交。我们将要解决的总体问题是：在哪里有机会减轻穷人的癌症负担？医疗补助中的癌症护理能够实现合理的质量基准？医疗补助中的种族差异是否持续存在？具体来说，我们将根据使用Medicare-Registry链接的数据来评估我们对团队的先前工作的良好理解的护理方面：1）诊断时的舞台分布，这是癌症严重程度和获得医疗服务的标志； 2）癌症手术和在经验丰富的医院接受较高手术量的复杂操作； 3）这些干预措施改善预后的癌症的辅助放射和化学疗法治疗。分析将集中于两组医疗补助参与者之间的常见实体瘤：年龄在21-64岁的成年人和65岁以上的老年人双重招收。我们将评估医疗补助患者的护理模式以及数据允许的地方，将其与其他未覆盖的医疗补助覆盖的类似人的模式进行比较。具体而言，对于癌症护理的每个重要方面，我们还将在医疗补助计划中衡量种族/族裔差异，并测试我们的假设，即在诊断前长期入学的患者将其最小化。更一般而言，该项目将为卫生服务研究人员建立资源，表征其产量，并利用它来识别和优先级，以改善弱势美国人的癌症护理提供的特定机会。公共卫生相关性：癌症护理对所有美国人都不如应有。众所周知，对于贫穷的人来说，护理是最佳的，其中许多人受国家医疗补助计划的保险。这项研究提出了一个问题，对于从州医疗补助计划中获得健康保险的患者来说，癌症护理是否应该像它一样好吗？长期使用医疗补助的患者是否患有更高级的舞台疾病？他们会得到必要的治疗吗？医疗补助计划中是否存在基于种族和种族的护理差距？对医疗补助索赔的信息是否足够可靠，以确定手术，放射和化学疗法等癌症治疗的重要方面？医疗补助注册和/或索赔数据与癌症注册表数据的联系是否可以为持续监视护理质量提供框架吗？通过检查来自纽约和加利福尼亚的数据，这些数据拥有大量的多种族人群和许多生活在贫困中的人，这项研究将回答这些问题，并确定改善癌症护理给贫困美国人的机会。