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）：癌症护理方面的缺陷对少数群体成员造成不成比例的影响，并导致癌症死亡率的种族和民族差异。医疗补助保险覆盖的近 1500 万美国成年人中有许多是黑人或西班牙裔，因此，在这些州健康保险计划的背景下评估癌症护理服务是确定差异来源的合理策略。通过将医疗补助登记和索赔文件与来自纽约和加利福尼亚州这两个拥有大量种族多元化人口和许多医疗补助登记者的州的肿瘤登记数据合并，我们试图确定获得安全网健康保险和种族/民族与常见癌症诊断的关系。我们要解决的首要问题是：哪里有机会减少穷人的癌症负担？医疗补助中的癌症护理服务是否达到了合理的质量基准？医疗补助中治疗方面的种族差异是否持续存在？具体来说，我们将根据我们团队之前使用医疗保险登记相关数据的工作来评估我们充分了解的护理方面：1) 诊断时的分期分布，这是癌症严重程度和获得医疗护理的标志； 2）癌症手术及在经验丰富的医院接受复杂手术、手术量大； 3) 癌症的辅助放疗和化疗治疗，这些干预措施可以改善结果。分析将重点关注两组医疗补助参与者中常见的实体瘤：双重参加医疗保险的 21-64 岁成年人和 65 岁以上老年人。我们将评估医疗补助患者的护理模式，并在数据允许的情况下，将其与医疗补助未涵盖的其他类似人员的模式进行比较。具体来说，对于癌症护理的每个重要方面，我们还将衡量医疗补助计划内的种族/民族差异，并检验我们的假设，即对于诊断前长期入组的患者，这种差异最小化。更一般地说，该项目将为卫生服务研究人员构建资源，描述其产量，并利用它来确定和优先考虑改善弱势美国人癌症护理服务的特定机会。公共卫生相关性：对于所有美国人来说，癌症护理并没有达到应有的水平。众所周知，对于穷人来说，护理并不是最理想的，他们中的许多人都有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，癌症护理是否达到了应有的水平？长期享受医疗补助的患者是否患有更晚期的疾病？他们是否接受必要的治疗？医疗补助计划中是否存在基于种族和族裔的护理差距？医疗补助索赔中记录的信息是否足够可靠，足以识别癌症治疗的重要方面，例如手术、放疗和化疗？将医疗补助登记和/或索赔数据与癌症登记数据联系起来能否为持续监测护理质量提供一个框架？通过检查来自拥有大量多种族人口和许多贫困人口的纽约和加利福尼亚州的数据，这项研究将回答这些问题并确定改善向贫困美国人提供癌症护理服务的机会。