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，在大容量设施中接受治疗的乳腺癌患者有更好的长期治疗效果。 为了生存，纽约州卫生部颁布了一项强制性区域化政策，据此，它不会 报销小批量设施，即每年少于 30 例全付费乳腺癌手术的设施， 在此应用程序中，我们利用了自然的优势。 纽约医疗补助区域化裁决（此处称为“政策”）提供的实验，以检验其影响 关于大约 15,000 名纽约居民的数量、结果和获得护理的机会的分布 具体来说，我们的目标是： 1. 确定每年因乳腺癌而接受手术的患者。 该政策在多大程度上导致医疗补助乳腺癌患者平均接受更多治疗 2. 通过检查生存率来评估该政策对患者结果的影响 纽约州医疗补助乳腺癌患者的比例相对于政策实施前的水平有所改善；以及 3. 量化意外情况； 通过估计该政策对获得治疗的影响来评估该政策的不利后果，并模拟贸易 使用“差中差”计算不同“低容量”阈值下的生存率和访问率之间的差异。 通过不同的技术，我们将纽约医疗补助乳腺癌患者的经历与历史和 纽约州医疗保险和商业保险乳腺癌患者以及新泽西州的同时观察数据 医疗补助乳腺癌患者，评估该政策对结果（即 5 年全因）的影响 乳腺癌特定的死亡率和生存率，以及获取措施，即治疗的距离/时间 从诊断到初始治疗的设施和时间，根据患者的社会人口统计、肿瘤和市场进行调整 对结直肠癌患者的系列队列进行的分析将提供更多的信息。 尽管人们的兴趣日益浓厚，但纽约州政策中体现的方法并不是一种有效的方法。 毫无争议的主张，因此提出其影响的证据将对 鉴于乳腺癌患者数量众多，支持（或反对）其更广泛传播的论据。 有证据表明患者的社会经济地位和结果导致结果存在一致和持续的差异 医院数量，以及有关区域化乳房的挑战和价值的未解决问题 癌症护理，这项研究的结果将对政策和计划的制定产生重大影响。

项目成果

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

护理区域化能否减少乳腺癌生存率的社会经济差异？

• 发表时间: 2021-01
• 影响因子: 3
• 作者: Nattinger, Ann B;Rademacher, Nicole;McGinley, Emily L;Bickell, Nina A;Pezzin, Liliana E
• 通讯作者: Pezzin, Liliana E

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。

• 发表时间: 2023-04-10
• 作者: Nattinger, Ann B;Bickell, Nina A;Schymura, Maria J;Laud, Purushottam;McGinley, Emily L;Fergestrom, Nicole;Pezzin, Liliana E
• 通讯作者: Pezzin, Liliana E