Can regionalization improve outcomes and reduce disparities related to breast cancer care? An Evaluation of the NY Medicaid regionalization experiment

区域化能否改善结果并减少与乳腺癌护理相关的差异？

• 批准号: 10201529
• 负责人: Ann B Nattinger
• 金额: $ 35.78万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201529
• 关键词: Adverse effects; Age; Breast Cancer Patient; Breast Cancer Treatment; Caring; Cessation of life; Characteristics; Colorectal Cancer; County; Data; Diagnosis; Diffusion; Disease; Esophagus; Evaluation; Eye; Goals; Grant; Health; Health Services Accessibility; Hospitals; Insurance Carriers; Intervention; Malignant Neoplasms; Measures; Medicaid; Medicare; Natural experiment; New York; Observational Study; Operative Surgical Procedures; Outcome; Pancreas; Patient-Focused Outcomes; Patients; Policies; Policy Developments; Postoperative Period; Program Development; Publishing; Race; Research; Research Personnel; Selection Bias; Socioeconomic Status; Techniques; Time; Time trend; Travel; Uninsured; Woman; Work; adverse outcome; base; beneficiary; breast cancer survival; cancer care; cancer surgery; cohort; comparison group; disparity reduction; experience; experimental study; hazard; improved; improved outcome; interest; low socioeconomic status; malignant breast neoplasm; mortality; mortality risk; negative affect; residence; sociodemographics; survival disparity; tumor

Prompted by evidence suggesting that breast cancer patients treated in high-volume facilities have better long- term survival, the NY State Dept of Health enacted a mandatory regionalization policy whereby it would not reimburse low-volume facilities, defined as those with less than 30 all-payer breast cancer surgeries per year, for breast cancer surgeries provided to its beneficiaries. In this application, we take advantage of the natural experiment afforded by NY's Medicaid regionalization ruling (referred here as The Policy) to examine its impact on the distribution by volume, outcomes, and access to care for the approximately 15,000 NY residents undergoing surgery for an incident breast cancer every year. Specifically, our aims are: 1. To determine the extent to which The Policy led to Medicaid breast cancer patients, on average, being treated in higher volume facilities; 2. To evaluate the impact of The Policy on patient outcomes by examining the extent to which survival of NY Medicaid breast cancer patients improved relative to pre-Policy levels; and 3. To quantify unanticipated adverse consequences of The Policy by estimating its impact on access to treatment, and to simulate trade- offs between survival and access at different “low-volume” thresholds. Using difference-in-difference-in- difference techniques, we contrast the experience of NY Medicaid breast cancer patients to historical and concurrent observational data on NY Medicare and commercially-insured breast cancer patients, as well as NJ Medicaid breast cancer patients, to estimate the effect of The Policy on outcomes, namely 5-year all-cause and breast-cancer-specific mortality and survival, and access measures, namely distance/time to treating facility and time from diagnosis to initial treatment, adjusting for patient's sociodemographic, tumor, and market characteristics. Analyses conducted with serial cohorts of patients with colorectal cancer will provide additional comparison groups. Despite increasing interest, the approach embodied in NY's Policy is not an uncontroversial proposition, so that adducing evidence of its impact would make a significant contribution to arguments for (or against) its broader diffusion. Given the large numbers of breast cancer patients, the evidence of consistent and persistent disparities in outcomes by the patients' socioeconomic status and hospital volume, and the unresolved questions concerning the challenges and value of regionalized breast cancer care, the results of this study will have significant implications for both policy and program development.

有证据表明，在大批量设施中接受治疗的乳腺癌患者的长期很长 定期生存，纽约州卫生部制定了强制性的区域化政策，因此不会 偿还低量的设施，定义为每年少于30个全付乳腺癌手术的设施 乳腺癌手术向其受益人提供。在此应用中，我们利用自然 纽约的医疗补助区域化裁决（此处称为政策）进行的实验以检查其影响 关于大约15,000名纽约居民的数量，结果和获得护理的分配 每年接受事件的乳腺癌手术。具体来说，我们的目标是：1。确定 平均而言，该政策导致医疗补助乳腺癌患者的范围​​较高治疗 设施; 2。通过检查生存的程度来评估政策对患者预后的影响 纽约医疗补助乳腺癌患者相对于政治前水平有所改善；和3。量化意外 通过估计其对获得治疗的影响并模拟贸易的不利后果 - 在不同的“小批量”阈值下生存和访问之间的折扣。使用差分差异内 - 差异技术，我们将纽约医疗补助乳腺癌患者的经验与历史和 关于纽约医疗保险和商业保险乳腺癌患者以及NJ的同时观察数据 医疗补助乳腺癌患者，以估计政策对结果的影响，即5年全原因 以及特定于乳腺癌的死亡率和生存，以及访问措施，即治疗的距离/时间 从诊断到初始治疗的设施和时间，调整患者的社会人口统计学，肿瘤和市场 特征。与结直肠癌患者一起进行的分析将提供额外 比较组。尽管兴趣越来越大，但在纽约政策中体现的方法并不是 毫无争议的提议，因此增加其影响的证据将为 争论（或反对）更广泛的差异。考虑到大量乳腺癌患者， 患者的社会经济地位和 医院数量以及有关区域化乳房挑战和价值的未解决的问题 癌症护理，这项研究的结果将对政策和计划制定产生重大影响。

项目成果

Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?

• DOI: 10.1097/mlr.0000000000001456
• 发表时间: 2021-01
• 期刊: Medical care
• 影响因子: 3
• 作者: Nattinger AB;Rademacher N;McGinley EL;Bickell NA;Pezzin LE
• 通讯作者: Pezzin LE

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer.

集中初始护理并提高贫困乳腺癌患者的生存率。

• DOI: 10.1200/jco.22.02012
• 发表时间: 2023
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Nattinger,AnnB;Bickell,NinaA;Schymura,MariaJ;Laud,Purushottam;McGinley,EmilyL;Fergestrom,Nicole;Pezzin,LilianaE
• 通讯作者: Pezzin,LilianaE