(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：
8927582
负责人：
Ann B Nattinger
金额：
$ 68.08万
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/8927582
关键词：
Adoption Advocacy Age American American Society of Clinical Oncology Behavior Benchmarking Breast Breast Cancer therapy Budgets Cancer Intervention Caring Categories Cellular Phone 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 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 Societies Study models Surgeon System Testing Third-Party Payer Time Ursidae Family Wisconsin Woman base behavior change behavior influence cancer care cohort design evidence base follow-up health care quality improved innovation interest malignant breast neoplasm medical specialties novel oncology operation peer programs response statistics tool treatment as usual trend web site

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）：受到公众舆论、同行和国会预算办公室的挑战，许多专业协会最近开始制定相对昂贵的程序的“前五名”清单，这些程序至少不会为某些类别的患者提供有意义的好处。通常为其订购的患者。最明显的例子是由美国内科医学委员会发起并得到大多数主要医学专业协会拥护的“Choose Wisely(R)”活动。然而，这些清单的制定在多大程度上影响了医生或患者的行为仍然未知。在此应用程序中，我们将使用威斯康星州医疗保健质量合作组织 (WCHQ)，这是一个由医院、医疗实践和卫生系统组成的全州联盟，作为实验室来检查两种组织干预措施的有效性：(i) “基本” “公共报告干预措施，在公共网站上总结有关使用针对乳腺癌的无效或未经证实的针对性干预措施的实践水平统计数据，以及（ii）“增强”干预措施，通过基于智能手机的应用程序增强公共报告(App) 为提供者提供及时信息、决策工具和个性化患者教育材料，支持根据 Choose Wisely(R) 或国家肿瘤学会指南减少乳腺癌干预措施的使用。具体来说，我们的目标是：(1) 使用 Marketscan 和 Medicare 索赔数据，研究相对于比较州的常规护理，在干预州的当代乳腺癌发病患者队列中，基本公开报告是否减少了靶向乳腺癌治疗的使用同时调整可能的混杂因素和时间趋势。 (2) 使用应用于 WCHQ 提供者的整群随机设计来检验强化干预相对于基本干预的有效性； (3) 模拟在全国范围内实施这两种干预措施（相对于彼此以及相对于常规护理）所带来的成本节约，并描述这些研究结果对报销政策和计划举措的影响。研究结果将提供严格的证据，证明独特的全付款人、全年龄公共报告系统的有效性，该系统有可能导出到其他州，以及影响提供者行为的新方法（应用程序）的严格证据。研究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人都很重要，包括政府、政策制定者、付款人、医疗保健提供者和消费者。结果将进一步与 ACO 环境相关，预计该环境将为提供无效或未经证实的护理提供经济抑制。