Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Prev Med. 2017 Aug;101:15-17. doi: 10.1016/j.ypmed.2017.05.017. Epub 2017 May 18.
Cancer preventive services, when used appropriately, result in improved health, better quality of life and decreased costs. For these reasons, cancer preventive services represent important priorities within the Affordable Care Act (ACA). Among the many provisions to improve access to preventive services the ACA introduced Accountable Care Organizations (ACOs) as trajectory to deliver coordinated, high-quality care. In order to evaluate this benchmark, we analyzed (in 2016/Boston) screening prevalence of breast cancer, a recommended screening test according to the United States Preventive Services Task Force (USPSTF), and prostate cancer, for which screening is no longer recommended by the USPSTF, among traditional Medicare beneficiaries and those enrolled in ACOs. We used propensity-score weighting to adjust for baseline confounders. We found that the prevalence of breast cancer screening (35.0% vs. 25.2%, p<0.001) and prostate cancer screening (54.6% vs. 41.7%, p<0.001) is higher among ACO enrollees. Our results suggest increased utilization of cancer preventive care within ACOs, regardless of whether the test is recommended or not. Better efforts may be needed within the ACO infrastructure to encourage recommended preventive care, but also penalize unnecessary use of low value services.
癌症预防服务，如果使用得当，会改善健康状况、提高生活质量并降低成本。出于这些原因，癌症预防服务是《平价医疗法案》（ACA）的重要优先事项之一。为了增加获得预防服务的机会，ACA 引入了责任医疗组织（ACO），作为提供协调、高质量护理的途径。为了评估这一基准，我们分析了（2016 年/波士顿）传统 Medicare 受益人和 ACO 参保者中，美国预防服务工作组（USPSTF）推荐的乳腺癌筛查以及 USPSTF 不再推荐的前列腺癌筛查的筛查率。我们使用倾向评分加权来调整基线混杂因素。我们发现，ACO 参保者中乳腺癌筛查（35.0%对 25.2%，p<0.001）和前列腺癌筛查（54.6%对 41.7%，p<0.001）的比例更高。我们的研究结果表明，ACO 内癌症预防护理的利用率增加，无论该测试是否被推荐。可能需要在 ACO 基础设施中做出更好的努力，以鼓励推荐的预防护理，同时惩罚不必要的低价值服务的使用。
