Gross C P, Krumholz H M
Sections of General Internal Medicine, Yale University School of Medicine, Primary Care Center, 333 Cedar St, PO Box 208025, New Haven, CT 06520, USA.
J Clin Oncol. 2005 Jun 1;23(16):3811-8. doi: 10.1200/JCO.2005.00.430.
To determine the relationship between managed care market activity and cancer trial enrollment.
Trial participant data were obtained from the National Cancer Institute. Participants in cooperative group trials of breast, colorectal, lung, or prostate cancer during the years 1996 through 2001 were assigned to counties based on their zip code of residence. Linear regression was used to determine the relationship between county enrollment rate and two measures of county managed care activity (penetration and index of competition [IOC]), adjusting for other county characteristics.
In bivariate analysis, there was a strong inverse correlation between trial enrollment rate and IOC (r = -0.23; P < .001) as well as the proportion of the population uninsured (-0.31; P < .001) and the percentage below poverty (-0.16; P < .001). In the multivariate model, greater county managed care competition (IOC) was inversely related to trial enrollment rate (P < .008 for comparison of each quartile v lowest quartile) after accounting for managed care penetration, proportion uninsured, and other county characteristics. Counties in the lowest quartile of managed care penetration tended to have lower enrollment rates than the remaining counties (r = -0.05; P = .048), while counties in the second, third, and fourth quartiles of penetration all had similar enrollment rates to one another.
Cancer trial enrollment rates were suboptimal across all counties, and counties with higher levels of managed care competition had significantly lower enrollment rates. The relationship between managed care penetration and trial enrollment was less consistent. Future efforts to enhance trial participation should address the potential negative influence of market factors.
确定管理式医疗市场活动与癌症试验入组之间的关系。
试验参与者数据来自美国国立癌症研究所。1996年至2001年期间参与乳腺癌、结直肠癌、肺癌或前列腺癌合作组试验的参与者根据其居住邮政编码被分配到各县。采用线性回归来确定县入组率与县管理式医疗活动的两项指标（渗透率和竞争指数[IOC]）之间的关系，并对其他县特征进行调整。
在双变量分析中，试验入组率与IOC之间存在很强的负相关（r = -0.23；P <.001），与未参保人口比例（-0.31；P <.001）以及贫困线以下人口百分比（-0.16；P <.001）也存在负相关。在多变量模型中，在考虑了管理式医疗渗透率、未参保比例和其他县特征后，更高的县管理式医疗竞争（IOC）与试验入组率呈负相关（每个四分位数与最低四分位数比较，P <.008）。管理式医疗渗透率处于最低四分位数的县的入组率往往低于其余县（r = -0.05；P =.048），而渗透率处于第二、第三和第四四分位数的县的入组率彼此相似。
所有县的癌症试验入组率都未达到最佳水平，管理式医疗竞争程度较高的县的入组率明显较低。管理式医疗渗透率与试验入组之间的关系不太一致。未来提高试验参与率的努力应解决市场因素的潜在负面影响。
