Health and Financial Costs of Unequal Care: Colorectal Cancer as a Case Study

不平等护理的健康和财务成本：结直肠癌案例研究

基本信息

批准号：
10656807
负责人：
CAROLYN M RUTTER
金额：
$ 48.12万
依托单位：
FRED HUTCHINSON CANCER CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-23 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10656807
关键词：
Accounting Address Affect Age Alaska Native Algorithms American American Indians Asian Awareness Bayesian Analysis Black American Black Populations Black race Calibration Cancer Etiology Caring Case Study Cessation of life Characteristics Clinical Collaborations Colonoscopy Colorectal Cancer Complex Continuity of Patient Care Costs and Benefits Data Decision Making Diagnosis Disadvantaged Disease Disparity Early Diagnosis Economics Elements Equity Ethnic Origin Ethnic Population Feces Financial cost Future Goals Guidelines Health Health Care Costs Health Policy Healthcare Hispanic Human Incidence Income Individual Institutional Racism Insurance Insurance Coverage Intervention Knowledge Life Malignant Neoplasms Measures Mediating Methods Modeling Natural History Not Hispanic or Latino Outcome Pacific Islander Patients Persons Policies Polypectomy Population Process Qualifying Quality-Adjusted Life Years Race Recommendation Records Research Review Literature Risk Rural Stage at Diagnosis Testing Treatment Cost Uncertainty Update Variant Work black patient cancer care cancer health disparity care costs care outcomes caucasian American colon cancer patients colorectal cancer prevention colorectal cancer risk colorectal cancer screening colorectal cancer treatment cost curative treatments design disparity reduction economic outcome electronic health system ethnic difference ethnic disparity experience follow-up health care disparity improved information gathering innovation insight member model development models and simulation mortality multidisciplinary outcome disparities outreach patient population racial difference racial disparity racial population screening simulation societal costs statistics success trend uptake urban residence years of life lost

项目摘要

ABSTRACT There is increasing awareness of systematic racism in US health care. Clinical algorithms that include race, which are often incorporated into electronic health systems meant to facilitate guideline care, are a striking example of overt and systemic differences in recommended care. Differences in care and reasons for these differences are often more difficult to identify and address. Colorectal cancer (CRC) care provides a case study. There is ample evidence of racial disparities in every step of the colorectal cancer care continuum, from early detection to treatment, especially for differences between Black patients and White patients. Compared to White people, Black people are less likely to be screened for CRC, less likely to receive endoscopic tests at high-quality facilities, more likely to be diagnosed at a later stage, less likely to receive curative treatment – even after accounting for stage at diagnosis, and have 40% higher mortality and shorter stage-specific survival. These differences in care have both health and economic consequences. In addition to worse outcomes, Black people have higher CRC-attributable treatment costs. We propose to extend and apply CRC-SPIN, an established microsimulation model for CRC, to synthesize the available evidence related to racial and ethnic differences in CRC risk, CRC care, and costs of care. We will extend CRC-SPIN, which currently simulates the overall US population, to simulate the natural history of CRC among specific racial and ethnic groups represented in SEER data (American Indian/Alaska Native, Asian or Pacific Islander, Black, White and Hispanic/non-Hispanic). Extension of CRC-SPIN to include race/ethnicity will focus on incorporating available information about differences in CRC risk. We will also extend CRC-SPIN to simulate patient characteristics beyond race/ethnicity that are related to screening, such as insurance status, which mediate the relationship between race/ethnicity and CRC care. We will use the resulting model to simulate the overall impact of disparate care on CRC outcomes, and to identify elements of the care process that have the largest impact on outcomes to better guide health policy. Health outcomes will include life years lost, disease-free life years lost, excess CRC, and excess late-stage CRC. Financial outcomes will assess societal costs, including screening costs, treatment costs and lost income both overall and for specific racial/ethnic groups. We will use robust decision making approaches to address uncertainty in the differential risk of CRC and differential CRC care. We will use the model to project the impact of policy scenarios designed to reduce racial/ethnic disparities in CRC to assist in identify the most effective policy scenarios for reducing racial/ethnic disparities in CRC.

抽象的人们越来越意识到美国医疗保健中的系统性种族主义，包括种族、它们通常被纳入电子卫生系统，旨在促进指导护理，这是一个引人注目的推荐护理方面的明显和系统性差异的示例及其原因。差异通常更难以识别和解决，结直肠癌 (CRC) 护理提供了一个案例。研究中有充分的证据表明结直肠癌护理连续过程的每一步都存在种族差异。早期发现到治疗，特别是黑人患者和白人患者之间的差异。对于白人来说，黑人接受结直肠癌筛查的可能性较小，接受内窥镜检查的可能性也较小高质量的设施，更容易在后期确诊，更不可能接受治愈性治疗—— 即使考虑到诊断时的分期，死亡率也会高出 40%，且分期特异性生存期更短。这些护理方面的差异除了导致更糟糕的结果外，还会对健康和经济造成影响。人们的 CRC 治疗费用较高，我们建议扩展并应用 CRC-SPIN，这是一种建立CRC的微观模拟模型，综合与种族和民族相关的现有证据 CRC 风险、CRC 护理和护理费用方面的差异我们将扩展 CRC-SPIN，目前它模拟了 CRC-SPIN。美国总体人口，以模拟特定种族和族裔群体中 CRC 的自然史以 SEER 数据表示（美洲印第安人/阿拉斯加原住民、亚洲或太平洋岛民、黑人、白人和 CRC-SPIN 的扩展以包括种族/族裔将重点关注纳入可用的我们还将扩展 CRC-SPIN 以模拟患者特征。除了与筛查相关的种族/民族之外，例如调解关系的保险状况我们将使用所得模型来模拟种族/民族与 CRC 护理之间的总体影响。 CRC 结果的不同护理，并确定对 CRC 结果影响最大的护理过程要素更好地指导卫生政策的结果将包括损失的生命年、损失的无病生命年、过多的 CRC 和过多的晚期 CRC 财务结果将评估社会成本，包括筛查。总体费用、治疗费用和收入损失，以及特定种族/族裔群体的费用，我们将使用稳健的方法。解决 CRC 差异风险和差异 CRC 护理的不确定性的决策方法。我们将使用该模型来预测旨在减少种族/民族差异的政策情景的影响 CRC 协助确定减少 CRC 种族/民族差异的最有效的政策方案。