Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
Cancer. 2018 Aug;124(16):3364-3371. doi: 10.1002/cncr.31573. Epub 2018 Jun 15.
Accountable care organizations (ACOs) have been shown to reduce prostate cancer treatment among men unlikely to benefit because of competing risks (ie, potential overtreatment). This study assessed whether the level of engagement in ACOs by urologists affected rates of treatment, overtreatment, and spending.
A 20% sample of national Medicare data was used to identify men diagnosed with prostate cancer between 2012 and 2014. The extent of urologist engagement in an ACO, as measured by the proportion of patients in an ACO managed by an ACO-participating urologist, served as the exposure. The use of treatment, potential overtreatment (ie, treatment in men with a ≥75% risk of 10-year noncancer mortality), and average payments in the year after diagnosis for each ACO were modeled.
Among 2822 men with newly diagnosed prostate cancer, the median rates of treatment and potential overtreatment by an ACO were 71.3% (range, 23.6%-79.5%) and 53.6% (range, 12.4%-76.9%), respectively. Average Medicare payments among ACOs in the year after diagnosis ranged from $16,523.52 to $34,766.33. Stronger urologist-ACO engagement was not associated with treatment (odds ratio, 0.87; 95% confidence interval, 0.6-1.2; P = .4) or spending (9.7% decrease in spending; P = .08). However, urologist engagement was associated with a lower likelihood of potential overtreatment (odds ratio, 0.29; 95% confidence interval, 0.1-0.86; P = .03).
ACOs vary widely in treatment, potential overtreatment, and spending for prostate cancer. ACOs with stronger urologist engagement are less likely to treat men with a high risk of noncancer mortality, and this suggests that organizations that better engage specialists may be able to improve the value of specialty care. Cancer 2018. © 2018 American Cancer Society.
有研究表明，由于存在竞争风险（即潜在过度治疗），问责制医疗照护组织（ACO）的出现降低了不太可能受益的男性的前列腺癌治疗率。本研究评估了泌尿科医生参与 ACO 的程度是否会影响治疗率、过度治疗率和支出。
使用全国性 Medicare 数据的 20%抽样，识别 2012 年至 2014 年间被诊断患有前列腺癌的男性。以 ACO 参与医生管理的 ACO 患者比例衡量泌尿科医生参与 ACO 的程度，作为暴露因素。对每个 ACO 的治疗使用、潜在过度治疗（即，在 10 年非癌症死亡率≥75%风险的男性中治疗）和诊断后一年的平均支付进行建模。
在 2822 名新诊断患有前列腺癌的男性中，ACO 的治疗率和潜在过度治疗率中位数分别为 71.3%（范围，23.6%-79.5%）和 53.6%（范围，12.4%-76.9%）。诊断后一年 ACO 之间的平均 Medicare 支付额从 16523.52 美元到 34766.33 美元不等。泌尿科医生与 ACO 的合作程度增强与治疗（优势比，0.87；95%置信区间，0.6-1.2；P=0.4）或支出（支出降低 9.7%；P=0.08）无关。然而，泌尿科医生的参与与潜在过度治疗的可能性降低相关（优势比，0.29；95%置信区间，0.1-0.86；P=0.03）。
ACO 在前列腺癌的治疗、潜在过度治疗和支出方面存在很大差异。与泌尿科医生合作程度较强的 ACO 不太可能治疗具有高非癌症死亡率风险的男性，这表明能够更好地与专科医生合作的组织可能能够提高专科护理的价值。癌症 2018. © 2018 美国癌症协会。
