Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48105-2967, USA.
J Urol. 2010 Dec;184(6):2279-84. doi: 10.1016/j.juro.2010.08.002. Epub 2010 Oct 16.
Since health care in the United States is fragmented and expensive, 1 reform option focuses on improving care coordination as in the medical home model. To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists.
We identified 105,961 patients diagnosed with prostate cancer between 1992 and 2005 using Surveillance, Epidemiology and End Results-Medicare data. We assigned all health care for prostate cancer and nonprostate cancer diagnoses by provider specialty across 3 distinct phases of care, including initial, continuing care and end of life. We then identified service types and proportions of care across specialties.
Urologists provided most prostate cancer care (45.2%). Radiation oncologist involvement decreased from 27.4% of claims in the initial phase to 5.5% and 5.7% in the continuing care and end of life phases, respectively. Conversely medical oncology and to a lesser degree primary care captured a greater percent of ongoing prostate cancer care. In patients with prostate cancer 7,120,343 of 36,837,904 services (19.3%) were directly related to prostate cancer care. Primary care providers were responsible for 47% of overall health care in men with prostate cancer.
Urologists provided most prostate cancer care while primary care providers were responsible for most overall health care in men with prostate cancer. In light of current reforms directed at improving care coordination urologists serve as a logical starting point to improve care delivery in the broader context of a medical home.
由于美国的医疗保健体系分散且费用高昂，因此一种改革方案侧重于改善医疗服务模式的协调。为了更深入地了解前列腺癌护理协调情况，我们研究了前列腺癌护理的提供方式在初级保健医生和专家之间是如何划分的。
我们使用监测、流行病学和最终结果-医疗保险数据，确定了 1992 年至 2005 年间 105961 名前列腺癌患者。我们根据医生的专业，将所有前列腺癌和非前列腺癌诊断的医疗保健分配到护理的 3 个不同阶段，包括初始阶段、持续护理阶段和生命终末期。然后，我们确定了服务类型和各专业的护理比例。
泌尿科医生提供了大部分前列腺癌护理（45.2%）。放射肿瘤学家的参与度从初始阶段的 27.4%的索赔中逐渐下降，分别在持续护理阶段和生命终末期阶段下降至 5.5%和 5.7%。相比之下，医学肿瘤学和在较小程度上的初级保健医生则在更大程度上捕获了更多正在进行的前列腺癌护理。在患有前列腺癌的 7120343 名患者中，有 36837904 项服务（19.3%）与前列腺癌护理直接相关。初级保健医生负责前列腺癌男性患者总体医疗保健的 47%。
泌尿科医生提供了大部分前列腺癌护理，而初级保健医生则负责前列腺癌男性患者的大部分总体医疗保健。鉴于当前旨在改善协调的改革，泌尿科医生作为改善医疗服务模式的逻辑起点，将改善更广泛的医疗服务模式中的护理交付。
