(PQE3)A Statewide RCT to Reduce Use of Ineffective or Unproven Breast Cancer Care

(PQE3) 全州范围内的随机对照试验，以减少无效或未经证实的乳腺癌护理的使用

基本信息

批准号：
8791451
负责人：
Ann B Nattinger
金额：
$ 72.99万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-15 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8791451
关键词：
Adoption Advocacy Age American American Society of Clinical Oncology Behavior Benchmarking Breast Budgets Cancer Intervention Caring Categories Cost Savings Data Data Reporting Decentralization Decision Making Development Disease Disincentive Effectiveness Environment Eye Female Goals Government Guidelines Health Health Care Costs Health Personnel Health system Healthcare Hospitals Internal Medicine Intervention Laboratories Lawyers Malignant Neoplasms Medical Medical Oncology Medicare claim Meta-Analysis Methods Metric Online Systems Operative Surgical Procedures Patient Education Patients Physicians Policies Policy Maker Population Procedures Provider Public Opinion Radiation Oncology Randomized Relative (related person)Reporting Research Infrastructure Research Personnel Services Simulate Societies Study models Surgeon System Telephone Testing Third-Party Payer Time Ursidae Family Wisconsin Woman base behavior change behavior influence cancer care cancer therapy cohort design evidence base follow-up health care quality improved innovation interest malignant breast neoplasm medical specialties novel oncology operation peer programs public health relevance response statistics tool treatment as usual trend web site

Adoption Advocacy Age American American Society of Clinical Oncology Behavior Benchmarking Breast Budgets Cancer Intervention Caring Categories Cost Savings Data Data Reporting Decentralization Decision Making Development Disease Disincentive Effectiveness Environment Eye Female Goals Government Guidelines Health Health Care Costs Health Personnel Health system Healthcare Hospitals Internal Medicine Intervention Laboratories Lawyers Malignant Neoplasms Medical Medical Oncology Medicare claim Meta-Analysis Methods Metric Online Systems Operative Surgical Procedures Patient Education Patients Physicians Policies Policy Maker Population Procedures Provider Public Opinion Radiation Oncology Randomized Relative (related person)Reporting Research Infrastructure Research Personnel Services Simulate Societies Study models Surgeon System Telephone Testing Third-Party Payer Time Ursidae Family Wisconsin Woman base behavior change behavior influence cancer care cancer therapy cohort design evidence base follow-up health care quality improved innovation interest malignant breast neoplasm medical specialties novel oncology operation peer programs public health relevance response statistics tool treatment as usual trend web site

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项目摘要

DESCRIPTION (provided by applicant): Challenged by public opinion, peers and the Congressional Budget Office, a number of specialty societies have recently begun to develop "Top Five" lists of relatively expensive procedures that do not provide meaningful benefit to at least some categories of patients for whom they are commonly ordered. The Choosing Wisely(R) campaign, developed by the American Board of Internal Medicine and embraced by most of the major medical specialty societies, is the most visible example. The extent to which the development of these lists has influenced the behavior of physicians or patients, however, remains unknown. In this application, we will use the Wisconsin Collaborative for Healthcare Quality (WCHQ), a statewide consortium of hospitals, medical practices, and health systems, as a laboratory in which to examine the effectiveness of two organizational interventions: (i) a "basic" public reporting intervention which summarizes on a public website practice-level statistics regarding use of targeted ineffective or unproven interventions for breast cancer and (ii) an "enhanced" intervention, augmenting public reporting with a smart phone-based application (App) that gives providers just-in-time information, decision-making tools, and personalized patient education materials that support reductions in the use of breast cancer interventions targeted based upon Choosing Wisely(R) or national oncology society guidelines. Specifically, our aims are: (1) To examine whether basic public reporting reduces use of targeted breast cancer practices among a contemporary cohort of patients with incident breast cancer in the intervention state relative to usual care in comparison states, using Marketscan and Medicare claims data while adjusting for possible confounders and temporal trends. (2) To examine the effectiveness of the enhanced intervention relative to the basic intervention using a cluster-randomized design applied to WCHQ providers; and (3) To simulate cost savings forthcoming from nationwide implementation of both interventions (relative to each other and to usual care) and to describe the implications of these findings for reimbursement policy and program initiatives. The results will provide rigorous evidence regarding the effectiveness of a unique all-payer, all-age public reporting system that is potentially exportable to other states, a well as rigorous evidence regarding a novel method (App) for influencing provider behavior. The results will be important for all interested in the challenges of reducing ineffective or unproven care, including government, policy-makers, payers, health care providers, and consumers. The results will be further relevant to the ACO environment, which is expected to provide financial disincentives for providing ineffective or unproven care.

描述（由申请人提供）：受公众舆论，同行和国会预算办公室的挑战，许多专业社会最近开始制定“前五名”的相对昂贵程序的清单，这些程序对至少为他们通常订购的某些患者提供了有意义的好处。由美国内科委员会制定的，并由大多数主要医学专业社会所接受的明智选择（R）运动是最明显的例子。然而，这些清单的发展影响医生或患者的行为的程度仍然未知。在此应用程序中，我们将使用威斯康星州的医疗保健质量合作（WCHQ），这是一个全州医院，医疗实践和卫生系统的财团，作为一个实验室，以研究两种组织干预的有效性：（i）“基本的”公共报告涉及公共网站实践的乳腺统计信息，或者在公共网站实践中进行了跨越或不合适的统计学范围，或者（II）使用目标癌症（II）癌症（II）的使用（涉及目标癌症），以验证目标癌症（II）癌症（II）的使用（均为目标癌症）。 “增强”干预措施，通过基于电话的智能应用程序（APP）增强公开报告，该应用程序为提供者提供了及时的信息，决策工具和个性化的患者教育材料，这些材料支持减少基于选择（R）或国家肿瘤学协会指南的乳腺癌干预措施的使用。具体而言，我们的目的是：（1）检查基本公开报告是否会减少当代乳腺癌在干预状态中相对于比较状态中通常的护理状态的当代乳腺癌患者中的靶向乳腺癌实践，同时使用MarketScan和Medicare索赔数据，同时调整了可能的混淆者和时间趋势。（2）使用应用于WCHQ提供商的群集随机设计相对于基本干预的增强干预措施的有效性；（3）为了模拟全国范围内两种干预措施的实施（相对于彼此和通常的护理）的成本节省，并描述了这些发现对报销政策和计划计划的含义。结果将为可能出口到其他州的独特全年公共报告系统的有效性提供严格的证据，这是针对影响提供商行为的新方法（APP）的严格证据。结果对于所有对减少无效或未经证实的护理挑战感兴趣的所有感兴趣的人，包括政府，政策制定者，付款人，医疗保健提供者和消费者。结果将与ACO环境进一步相关，ACO环境有望为提供无效或未经证实的护理提供财务障碍。