Automated Delineation of Cancer Service Areas

自动划定癌症服务区域

基本信息

批准号：
9387606
负责人：
Tracy Onega
金额：
$ 22.06万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-14 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9387606
关键词：
Address American American Society of Clinical Oncology Area Area Analyses Atlases Cancer Patient Caring Censuses Clinical Communities Complex Congresses Continuity of Patient Care Detection Development Diagnosis Effectiveness Environment Evaluation Expenditure Future General Hospitals Geographic Information Systems Geography Goals Health Health Professional Healthcare Healthcare Market Healthcare Systems Hospital Referrals Hospitalization Hospitals Inpatients Institute of Medicine (U.S.)Malignant Neoplasms Measurement Measures Medicare Medicare claim Methodology Methods Modeling Network-based Oncologist Outcome Outpatients Patient Care Patients Pattern Policy Developments Policy Maker Population Population Characteristics Quality of Care Regional Cancer Reporting Resource Allocation Resources Services Specificity Structure System Technology Testing Time Translating Uncertainty United States Variant Work base beneficiary cancer care cancer diagnosis care delivery clinical phenotype comparative design health care delivery health care service utilization improved indexing interest novel palliation patient oriented patient population pressure programs service utilization survivorship user-friendly

项目摘要

ABSTRACT For over 20 years, health care delivery in the U.S. has been informed by methodologies that create “service areas”, such as Hospital Service Areas (HSAs) of the Dartmouth Atlas Project, to evaluate how health care resources are distributed across the population and how that impacts health outcomes. Policy makers have used these units to assess regional variation in health care utilization and quality to design strategies for improving health and health care systems. Delivery of cancer care in the United States represents a unique set of patients, technologies, clinical specialization, and patient- centered perspectives, distinct from other patient populations. The Institute of Medicine and the American Society of Clinical Oncology have recently noted that there is a “crisis” in cancer care delivery, and highlighted the need for meaningful ways to assess quality. We propose to develop a novel method to generate Cancer Service Areas (CSAs) – geospatial units analogous to HSAs, but specific to cancer care – in order to create a framework for assessing regional cancer care delivery, quality, and outcomes. Based on health care utilization captured through all-payer claims and Medicare claims, we will extend and refine the Dartmouth HSA model. The derived CSAs have several key distinctions from existing service area delineations: a) focus on cancer-specific patient population/diagnoses; b) inclusion of outpatient claims, in addition to inpatient, to capture continuum of care; c) refinement of a complex network-based community detection method to account for spatial patterns of patient care while attaining geographic contiguity of the CSAs; and d) creation of an automated program in a Geographic Information Systems (GIS) environment that adapts to user-defined sets of services, diagnoses, or clinical phenotypes. Our specific aims are to: 1) Develop Cancer Service Areas (CSAs)- unique, cancer-specific geographic units of healthcare utilization to evaluate cancer care through a refined methodologic approach; 2) Evaluate the CSAs versus Dartmouth HSAs to assess their spatial specificity to the population of interest; and 3) Demonstrate the utility of CSAs as unique spatial units with respect to the cancer population. Creation of CSAs is an urgent need for policymakers (e.g. Congress), decision leaders (e.g. ASCO), health care systems, and ultimately patients who seek reliable, reportable information on quality cancer care. It is a first step towards these goals, and promises to serve broad service area methodologies at the same time.

抽象的 20 多年来，美国的医疗保健服务一直遵循创建“服务区”的方法，例如达特茅斯地图集项目的医院服务区 (HSA)，用于评估医疗保健资源的分配方式以及这如何影响整个人口的健康结果。政策制定者利用这些单位来评估区域。医疗保健利用率和质量的变化，以设计改善健康和医疗保健系统的策略。美国的癌症护理代表了一套独特的患者、技术、临床专业化和患者- 与其他患者群体不同的以中心为中心的观点。临床肿瘤学最近指出，癌症护理服务存在“危机”，并强调需要我们建议开发一种新方法来生成癌症服务区 (CSA) – 类似于 HSA 的地理空间单位，但特定于癌症护理——以便创建一个评估区域的框架基于通过所有付款人索赔和获取的医疗保健利用率。 Medicare 声称，我们将扩展和完善达特茅斯 HSA 模型。衍生的 CSA 有几个关键区别。根据现有的服务区域划分： a) 关注特定癌症患者群体/诊断 b) 纳入门诊患者；除了住院病人之外，还可以获取连续护理的索赔 c) 完善基于网络的复杂社区；考虑患者护理空间模式的检测方法，同时实现 CSA 的地理连续性；d) 在地理信息系统 (GIS) 环境中创建适应用户定义的自动化程序我们的具体目标是： 1) 开发癌症服务领域 (CSA)- 独特的、针对癌症的医疗保健利用地理单位，通过完善的方法评估癌症护理 2) 评估 CSA 与达特茅斯 HSA，以评估它们对感兴趣人群的空间特异性； 3) 证明 CSA 作为癌症群体的独特空间单位的效用。政策制定者（例如国会）、决策领导人（例如 ASCO）、医疗保健系统以及最终的迫切需求寻求有关优质癌症护理的可靠、可报告信息的患者这是实现这些目标的第一步，并且承诺同时为广泛的服务领域方法提供服务。