Carpenter William R, Weiner Bryan J, Kaluzny Arnold D, Domino Marisa Elena, Lee Shoou-Yih Daniel
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Med Care. 2006 Jul;44(7):671-9. doi: 10.1097/01.mlr.0000220269.65196.72.
The National Institutes of Health is developing practice-based clinical research networks (PBRNs) to expedite the pace of scientific discovery and improve care quality. Anecdotal evidence suggests managed care penetration and provider competition negatively affect PBRN clinical research.
The objective of this study is to examine the effects of environmental factors on clinical research performance in the National Cancer Institute's Community Clinical Oncology Program (CCOP).
This study examined 49 CCOPs in 34 states using longitudinal (1991-2001) generalized least-squares regression including fixed effects, using secondary data from the National Cancer Institute, Group Health Association of America, InterStudy, American Hospital Association, Area Resource Files, and the Current Population Survey.
Performance was measured as CCOP-level accrual in treatment trials, cancer prevention and control (CP/C) trials, and all trials combined. HMO penetration served as a proxy for managed care penetration. Competition measures included both hospital competition and physician competition.
Managed care penetration was positively associated with accrual in areas of low to moderate penetration and negative in the areas of high penetration. Compared with areas with 5% penetration, areas with 15% penetration had 21% more treatment accrual and 66% more CP/C accrual. Compared with areas with 40% penetration, areas with 50% penetration had 11% lower treatment accrual and 3% lower CP/C accrual. CP/C accrual was more positively affected than treatment accrual. Greater hospital competition was associated with a decline in trial enrollment.
The healthcare environment appears to have a significant effect on accrual into community-based cancer treatment and CP/C clinical trials. Findings for treatment and CP/C accrual suggest each type of accrual is distinct and requires different strategies and administrative methods.
美国国立卫生研究院正在建立基于实践的临床研究网络（PBRN），以加快科学发现的速度并提高医疗质量。轶事证据表明，管理式医疗的普及和医疗服务提供者之间的竞争对PBRN临床研究产生负面影响。
本研究的目的是检验环境因素对美国国立癌症研究所社区临床肿瘤项目（CCOP）临床研究绩效的影响。
本研究使用1991 - 2001年的纵向广义最小二乘法回归（包括固定效应），对34个州的49个CCOP进行了研究，使用的数据来自美国国立癌症研究所、美国团体健康协会、InterStudy、美国医院协会、地区资源文件以及当前人口调查的二手数据。
绩效以CCOP层面在治疗试验、癌症预防与控制（CP/C）试验以及所有试验中的入组人数来衡量。健康维护组织（HMO）的渗透率被用作管理式医疗渗透率的代理指标。竞争指标包括医院竞争和医生竞争。
管理式医疗渗透率在低至中等渗透率地区与入组人数呈正相关，在高渗透率地区呈负相关。与渗透率为5%的地区相比，渗透率为15%的地区治疗入组人数多21%，CP/C入组人数多66%。与渗透率为40%的地区相比，渗透率为50%的地区治疗入组人数低11%，CP/C入组人数低3%。CP/C入组人数比治疗入组人数受到的积极影响更大。医院竞争加剧与试验入组人数下降有关。
医疗环境似乎对社区癌症治疗和CP/C临床试验的入组人数有显著影响。治疗和CP/C入组人数的研究结果表明，每种入组类型都各不相同，需要不同的策略和管理方法。
