Examining the effects of Global Budget Revenue Program on the Costs and Quality of Care Provided to Cancer Patients Undergoing Chemotherapy

检查全球预算收入计划对接受化疗的癌症患者提供的护理成本和质量的影响

基本信息

批准号：
10734831
负责人：
ANAEZE C OFFODILE
金额：
$ 62.41万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
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：
2023-09-13 至 2028-08-31
项目状态：
未结题

项目摘要

Project Summary/Abstract In 2014, the state of Maryland, under a federal waiver, enacted an all-payer Global Budget Revenue (GBR) model that prospectively set limits on hospital revenue. It also required the state to limit growth in per-capita spending and mandated reductions in preventable complications and readmissions. GBR implementation was associated with savings to the Medicare Trust Fund and considerations are now underway to expand the program to other regions. However, there is limited understanding of GBR’s impact on the delivery of cancer- related services. It is possible that while GBR may incentivize reduced healthcare expenditures and care improvements on average, it could be associated with unintended effects and poor performance for cancer patients by limiting access to effective cancer treatments. GBR may have deleterious effects on prevailing cancer care inequities by encouraging adverse patient selection towards racial minorities and patients with socioeconomic vulnerability due to concerns about higher spending and worse clinical outcomes. Current evaluations of the GBR program have not examined these impacts. We aim to address this evidence gap in this proposal. Our research is important because acute hospital care, the focus of GBR incentives, is a key driver of overall spending and regional variation in spending for patients with cancer. The objective of this proposal is to systematically examine, via a difference-in-differences design, the impact of the GBR model on spending, quality-of-care, and utilization among fee-for-service Medicare beneficiaries and nonelderly Medicaid and commercial insurance beneficiaries with cancer in Maryland compared with similar patients in control states. Our central hypothesis is that the financial incentives in GBR will lower spending, improve care quality, and facilitate a shift in the site of care for chemotherapy administration across our populations of interest. Additionally, we hypothesize that GBR implementation will lead to relatively worse clinical outcomes and relatively greater spending for historically marginalized patients. We will test our hypotheses and achieve our objectives with the following specific aims: Aim 1: Quantify the impact of GBR on risk-adjusted spending for beneficiaries undergoing chemotherapy. Aim 2: Assess the impact of GBR on the likelihood of chemotherapy receipt and on care quality for beneficiaries undergoing chemotherapy. Aim 3: Assess the impact of GBR on the type of chemotherapy (physician-administered vs. oral) and site of physician-administered chemotherapy (hospital outpatient department vs. physician office setting). Aim 4: Assess the differential effects of GBR implementation on care delivery for historically marginalized patients, based on area-level deprivation, race and ethnicity, and dual-eligible status, who are undergoing chemotherapy. Our findings will meaningfully advance our understanding of how to deliver efficient, high- quality cancer care to adult patients. It will also provide timely information to policy-makers that would guide updates to GBR and mitigate the risk of unintended consequences in future global budget initiatives.

项目概要/摘要 2014 年，马里兰州根据联邦豁免，颁布了全纳税人全球预算收入 (GBR) 该模型前瞻性地对医院收入设定了限制，它还要求国家限制人均收入的增长。 GBR 的实施是与医疗保险信托基金的储蓄有关，目前正在考虑扩大然而，人们对 GBR 对癌症传播的影响了解有限。尽管英国可能会鼓励减少医疗支出和护理服务。平均改善，可能与意想不到的效果和癌症治疗表现不佳有关限制 GBR 患者获得有效的癌症治疗可能会对当前流行的癌症产生有害影响。通过鼓励对少数族裔和患有以下疾病的患者进行不利选择来消除癌症护理不平等由于担心更高的支出和更差的临床结果，当前的社会经济脆弱性。 GBR 计划的评估尚未审查这些影响。我们的目标是解决这一证据差距。我们的研究很重要，因为急性住院护理是 GBR 激励措施的重点。总体支出的驱动因素以及癌症患者支出的区域差异。该提案的目的是通过双重差异设计系统地检查影响 GBR 模型关于按服务付费医疗保险受益人的支出、护理质量和利用率的分析与马里兰州患有癌症的非老年医疗补助和商业保险受益人相比我们的中心假设是，英国的经济激励将会降低。支出，提高护理质量，并促进化疗管理护理地点的转变此外，我们勇敢地说，GBR 的实施将导致相对更糟糕的情况。我们将测试我们的临床结果和历史老年患者相对较高的支出。假设并实现我们的目标，具体目标如下：目标 1：量化 GBR 对接受化疗的受益人的风险调整支出目标 2：评估 GBR 对接受化疗的影响。接受化疗的可能性以及接受化疗的患者的护理质量。 3：评估 GBR 对化疗类型（医生给药与口服）和化疗部位的影响医生实施的化疗（医院门诊部与医生办公室环境）。评估 GBR 实施对历史患者护理服务的不同影响，基于地区一级的贫困、种族和族裔以及双重资格身份，他们正在接受我们的研究结果将有意义地增进我们对如何提供高效、高效的化疗的理解。它还将为政策制定者提供及时的信息，为成年患者提供优质的癌症护理。更新 GBR 并降低未来全球预算计划中出现意外后果的风险。