The role of patient experiences with care in older adult colorectal cancer patients with comorbid chronic conditions

患者护理经历在患有慢性疾病的老年结直肠癌患者中的作用

• 批准号: 10704005
• 负责人: Stephanie Ariana Navarro
• 金额: $ 5.22万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-02 至 2026-09-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704005
• 关键词: Adherence; Administrator; Adult; Area; California; Cancer Patient; Cancer Survivor; Cancer Survivorship; Caring; Chronic; Chronic Disease; Chronic Kidney Failure; Chronic Obstructive Pulmonary Disease; Clinical; Colorectal Cancer; Communication; Complex; Congestive Heart Failure; Data; Data Set; Diagnosis; Disease Management; Disparate; Disparity; Doctor of Philosophy; Education; Elderly; Epidemiology; Ethnic Origin; Ethnic Population; Fee-for-Service Plans; Fellowship; Goals; Guidelines; Health Disparities Research; Health Information System; Health Personnel; Health Services; Healthcare; Hospitalization; Individual; Inpatients; Intervention; Link; Malignant Neoplasms; Medical Fee for Service; Medicare; Mentors; Modification; National Cancer Institute; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Patient-Centered Care; Patients; Physicians; Policy Maker; Population; Primary Care; Quality of Care; Race; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Role; SEER Program; Sampling; Stage at Diagnosis; Structure; Surveys; Survival Rate; Training; Training Programs; Universities; Vulnerable Populations; Work; anticancer research; cancer care; cancer diagnosis; cancer survival; care coordination; care costs; care outcomes; care providers; care systems; clinical training; cohort; colon cancer patients; colorectal cancer risk; comorbidity; cost; data registry; ethnic difference; ethnic diversity; ethnic minority; ethnic minority population; experience; follow-up; health assessment; health care disparity; health disparity; health equity; human old age (65+); improved; improved outcome; medical schools; medically underserved; minority patient; mortality; mortality risk; multiple chronic conditions; neoplasm registry; patient population; population based; programs; racial difference; racial diversity; racial minority; racial minority population; racial population; skills; survivorship

Project Summary Older adults living with chronic conditions and diagnosed with colorectal cancer (CRC) experience substandard cancer care, declines in care for their chronic conditions, and increased mortality relative to CRC patients with no additional chronic conditions. Given compounded disparities in care for racial/ethnic minority patients, non- white older adult CRC patients with comorbid chronic conditions experience even more disparate care and outcomes. Yet, little has been done to systematically seek to improve care and outcomes for this vulnerable patient group. One relatively simple solution may be to seek to optimize patients’ experiences with their care. Patients reporting better experiences with their care have greater adherence to care, improved outcomes, and decreased mortality amenable to healthcare. This research seeks to use Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to study the associations between patient experiences and health care, outcomes, and costs in a racially and ethnically diverse sample of older adult CRC patients with comorbid chronic conditions. Our specific aims are to determine racial/ethnic differences in: 1) associations between patient experiences with care and changes in chronic condition care use following CRC diagnosis in older adult patients; 2) effect modification of patient experiences with care in the relationships between comorbidity status and receiving guideline CRC care and CRC survivorship; and 3) associations between patient experiences with care and overall costs of care following CRC diagnosis in patients with and without comorbid chronic conditions. We hypothesize that, in a population-based and nationally representative cohort, older adult CRC patients with comorbid chronic conditions will have better outcomes when experiences with care are highly-rated, and that there will be disparities in these effects for racial/ethnic minority patients. Data for this research will come from the SEER- CAHPS linked dataset, using a sample of Medicare fee-for-service CRC patients with comorbid congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, or type 2 diabetes who responded to a CAHPS patient experience survey. The findings of this research will inform how we might optimize care for this vulnerable patient group and for the growing group of older adults with multimorbidity. Completion of this project will be aligned with a fellowship training plan with the goals of: 1) training in epidemiologic, health services, and health disparities research; 2) understanding multimorbidity in older adults and health disparities in later life; and 3) integrated longitudinal clinical training in primary care for medically underserved patients. This training will be conducted at the University of Southern California Keck School of Medicine (KSOM) with the support of skilled research and clinical mentors, ample research and clinical training resources, and involvements in structured training programs (such as the KSOM MD/PhD program; the Cancer Research, Education and Engagement Health Equity Center (CaRE2); and the KSOM Primary Care Program).

项目摘要 患有慢性疾病的老年人和结直肠癌诊断（CRC）经验不合格 癌症护理，对其慢性疾病的护理下降，相对于CRC患者的死亡率增加 没有其他慢性条件。给定对种族/族裔少数民族患者的护理中的复合分布，非 - 白人老年人CRC患者合并症慢性病的患者经历更加不同的护理和 结果。但是，几乎没有采取系统地寻求改善这种脆弱的护理和结果 患者组。一个相对简单的解决方案可能是寻求优化患者的护理经验。 报告提供更好护理经验的患者对护理，改善结果和 降低了医疗保健的死亡率。这项研究试图使用监视，流行病学和结局 结果（SEER） - 医疗保健提供者和系统（CAHPS）数据的消费者评估 患者体验与医疗保健，成果和成本之间的关联大致和种族 患有合并症的老年人CRC患者的不同样本。我们的具体目的是 确定种族/种族差异：1）患者的护理经历与变化之间的关联 老年患者CRC诊断后使用慢性病护理； 2）效果改变患者 在合并症状态与获得指导方指南CRC护理和 CRC生存； 3）患者经验与护理和整体护理成本之间的关联 在患有和没有合并症的慢性疾病患者的CRC诊断后。我们假设这是 基于人群和全国代表性的队列，合并症的老年人CRC患者 当护理经验高度评价时，条件将取得更好的结果，并且会有 这些影响对种族/族裔少数民族患者的差异。这项研究的数据将来自先知 CAHPS链接数据集，使用合并症的Medicare费用为服务费的CRC患者 心力衰竭，慢性肾脏疾病，慢性阻塞性肺疾病或2型糖尿病 回应了CAHPS患者体验调查。这项研究的结果将告知我们如何 优化对这个脆弱的患者组的护理，并为成长中的多个多发病的老年人组成。 该项目的完成将与奖学金培训计划保持一致：1）培训 流行病学，卫生服务和健康差异研究； 2）了解老年人的多个多发病 和后来的健康差异； 3）在医学上整合初级保健的纵向临床培训 服务不足的患者。该培训将在南加州大学凯克大学进行 医学（KSOM）在熟练的研究和临床导师的支持下，充分的研究和临床培训 资源以及参与结构化培训计划（例如KSOM MD/PHD计划；癌症 研究，教育和参与健康公平中心（CARE2）；和KSOM初级保健计划）。