Impact of Rural Hospital Payment and Delivery Reform on Geographic Disparities in Cancer Surgery

农村医院支付和服务改革对癌症手术地域差异的影响

• 批准号: 10401862
• 负责人: Lindsay Marie Sabik
• 金额: $ 59.3万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10401862
• 关键词: Accounting; Address; Affect; Age; Area; Budgets; Cancer Patient; Caring; Characteristics; Communities; Complex; Data; Face; Financial Hardship; Focus Groups; Goals; Health; Health Personnel; Health Services Accessibility; Healthcare; Heterogeneity; Hospital Administrators; Hospital Restructuring; Hospitals; Improve Access; Incentives; Incidence; Interview; Light; Link; Location; Malignant Neoplasms; Methods; Modeling; National Cancer Institute; Operative Surgical Procedures; Outcome; Patient-Focused Outcomes; Patients; Pattern; Pennsylvania; Phase; Policies; Population; Process; Provider; Qualitative Evaluations; Qualitative Methods; Quality of Care; Records; Regional Cancer; Resources; Risk; Rural; Rural Community; Rural Health; Rural Hospitals; Services; Site Visit; Stream; Surgeon; Surgical Oncology; Time; United States; United States Centers for Medicare and Medicaid Services; Variant; barrier to care; base; cancer care; cancer health disparity; cancer surgery; care delivery; care outcomes; data registry; design; econometrics; experience; experimental study; financial incentive; geographic disparity; health care availability; health care delivery; hospital readmission; implementation process; implementation science; improved; improved outcome; informant; innovation; medical specialties; mortality; neoplasm registry; novel strategies; payment; population health; programs; response; rural area; rural disparities; rural healthcare; rural patients; rural residence; surgery outcome; targeted delivery; tumor; urban area

Project Summary Cancer patients in rural areas have more limited access to specialized care, are less likely to receive certain treatments, and have poorer outcomes than their counterparts in non-rural areas. Over recent years, many rural hospitals have closed and a high proportion of remaining rural hospitals are in financial distress and at risk for closure, exacerbating barriers to care for rural patients. At the same time, evidence that the volume of surgeries performed in a hospital is associated with improved health outcomes, including mortality, has led to efforts to regionalize surgical care. Although the advantages of regionalization are well documented, referring cancer surgeries to high-volume centers presents challenges for patients, surgeons, and hospitals in rural communities. Against this complex backdrop, the state of Pennsylvania has initiated the Pennsylvania Rural Health Model (PRHM), an innovative program designed to provide hospitals with predictable revenue streams through global budgets and encourage participating hospitals to redesign care delivery to best meet the needs of their communities. This project will assess the impact of the PRHM on access to and outcomes associated with cancer surgery. First, we will examine the impact of the PRHM on regional cancer surgery delivery patterns by examining the location and characteristics of hospitals at which cancer patients receive surgery using statewide hospital discharge data. By decoupling payment from volume, PRHM changes the incentives for providers to perform surgeries locally versus referring patients to regional centers. We hypothesize that patients in areas served by PRHM hospitals will be more likely to be referred to high-volume centers than those in other rural hospital markets. Second, we will assess the effect of the PRHM on cancer surgery access and outcomes using linked discharge and cancer registry data. The PRHM emphasizes changes in care delivery that target improvements in population health, with a focus on access to specialty care. We hypothesize that surgical cancer patients in areas served by PRHM hospitals may experience improvements in receipt of recommended cancer surgery, time to surgery, and related health outcomes, including mortality and readmissions. Third, we will use qualitative methods to understand the PA Rural Health Model implementation process, including its impacts on resource utilization, hospital capabilities, staffing, care delivery, and financial incentives for providers. We will conduct interviews with key informants and focus groups with community stakeholders. Guided by a comprehensive conceptual model derived from implementation science, we will granularly assess the mechanisms by which PRHM succeeded or failed to affect hospital processes and outcomes for surgical cancer care. As the population in areas served by targeted hospitals continues to age, cancer incidence and the demand for high-quality surgical care will increase. Lessons from this context will be highly relevant for informing alternative payment models in rural hospitals and addressing the needs of surgical cancer patients in rural communities throughout the United States.

项目摘要 农村地区的癌症患者获得专业护理的机会更有限，不太可能获得某些人 治疗，比在非农村地区的同行效果差。近年来，许多 农村医院已经关闭，剩余的农村医院很大一部分处于财务困境和 关闭的风险，加剧对农村患者护理的障碍。同时，证据表明 在医院进行的手术与包括死亡率在内的改善健康结果有关，导致 努力进行外科手术护理。尽管区域化的优势已得到充分记录，但 大量中心的癌症手术给农村的患者，外科医生和医院带来了挑战 社区。在这个复杂的背景下，宾夕法尼亚州发起了宾夕法尼亚州农村 Health Model（PRHM）是一项创新计划，旨在为医院提供可预测的收入来源 通过全球预算，并鼓励参与的医院重新设计护理服务，以最佳满足需求 他们的社区。该项目将评估PRHM对访问和结果相关的影响的影响 进行癌症手术。首先，我们将检查PRHM对区域癌症手术分娩的影响 通过检查癌症患者接受手术的医院的位置和特征来进行模式 使用全州医院出院数据。通过将付款与数量分解，PRHM更改了激励措施 为了使提供者在本地进行手术，而不是将患者转介到区域中心。我们假设这一点 PRHM医院服务的地区的患者更有可能被转交给大容量中心 那些在其他农村医院市场。其次，我们将评估PRHM对癌症手术的影响 并使用链接的放电和癌症注册表数据的结果。 PRHM强调护理的变化 交付目标改善人口健康，重点是获得专业护理。我们 假设PRHM医院服务地区的外科癌症患者可能会有所改善 接受推荐的癌症手术，手术时间以及相关的健康结果，包括死亡率和 再入院。第三，我们将使用定性方法来了解PA农村健康模型实施 流程，包括其对资源利用，医院能力，人员配备，护理交付和财务的影响 提供者的激励措施。我们将对社区的关键线人和焦点小组进行访谈 利益相关者。在实施科学的全面概念模型的指导下，我们将 粒状评估PRHM成功或未能影响医院过程的机制 手术癌症护理的结果。随着目标医院服务地区的人口持续衰老， 癌症发病率和对高质量手术护理的需求将增加。从这种情况下的教训将是 与在农村医院通知替代付款模型的高度相关并满足手术需求 美国各地农村社区的癌症患者。