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.

抽象的在美国医疗保健中，人们对系统性种族主义的认识越来越高。包括种族的临床算法，通常将其纳入旨在促进准则护理的电子卫生系统中，是罢工推荐护理中明显和系统差异的示例。护理和这些原因的差异差异通常更难识别和解决。结直肠癌（CRC）护理提供了一个案例学习。在有色癌症护理连续体的每个步骤中，都有足够的证据表明种族差异早期检测到治疗，特别是对于黑人患者和白人患者之间的差异。比较的对于白人而言，黑人不太可能被筛选为CRC，在高质量的设施，更有可能在以后诊断出来，不太可能接受治疗治疗 - 即使在诊断时考虑了阶段，并且死亡率高40％，并且阶段特定的生存期更短。这些护理上的差异既具有健康和经济后果。除了更糟糕的结果，黑色人们具有更高的CRC促进治疗费用。我们建议扩展和应用CRC旋转，一个 CRC的建立微仿真模型，以合成与种族和种族有关的可用证据 CRC风险，CRC护理和护理成本的差异。我们将扩展CRC-Spin，目前正在模拟美国总体人口，以模拟特定种族和种族中CRC的自然历史代表Seer数据（美洲/阿拉斯加本地人，亚洲或太平洋岛民，黑人，白色和西班牙裔/非西班牙裔）。 CRC-Spin的扩展以包括种族/民族的范围，将集中于合并的可用有关CRC风险差异的信息。我们还将扩展CRC旋转以模拟患者特征超越与筛查有关的种族/民族，例如保险状态，这些保险状态可以调节关系在种族/种族和CRC护理之间。我们将使用结果模型模拟对CRC成果的不同护理，并确定对护理过程的要素，这些要素对结果可以更好地指导健康政策。健康成果将包括丧生的终生，无疾病的人生损失，过量的CRC和过量的晚期CRC。财务成果将评估社会成本，包括筛查整体和特定种族/族裔群体的成本，治疗成本和收入损失。我们将使用强大的解决CRC和CRC差异风险中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/种族分布的政策场景的影响 CRC协助确定减少CRC种族/种族差异的最有效政策方案。