Flatiron Health, New York, NY.
University of Pennsylvania, Philadelphia, PA.
JCO Oncol Pract. 2020 Oct;16(10):e1216-e1221. doi: 10.1200/JOP.19.00747. Epub 2020 Jun 4.
The Oncology Care Model (OCM) is Medicare's first alternative payment model program for patients with cancer. As of October 2017, participating practices were required to report biomarker testing of patients with advanced non-small-cell lung cancer (aNSCLC). Our objective was to evaluate the effect of this OCM reporting requirement on quality of care.
We selected patients with aNSCLC receiving care in practices in a nationwide de-identified electronic health record-derived database. We used an adjusted difference-in-differences (DID) logistic regression model to compare changes in biomarker testing rates (EGFR, ROS1, and ALK) and receipt of biomarker-guided therapy between patients in OCM versus non-OCM practices, before and after OCM implementation.
The analysis included 14,048 patients from 45 OCM practices (n = 8,151) and 105 non-OCM practices (n = 5,897). The overall unadjusted rates for biomarker testing and receipt of biomarker-guided therapy increased over the study period (2011-2018) in both OCM (55.5% 71.6%; 89.8% 94.6%, respectively) and non-OCM (55.2% 69.7%; 90.1% 95.2%, respectively) practices. In the adjusted DID model, the rates of biomarker testing (odds ratio [OR], 1.09 [95% CI, 0.88 to 1.34]; = .45) and receipt of biomarker-guided therapy (OR, 0.87 [95% CI, 0.52 to 1.45]; = .58) were similar between OCM and non-OCM practices.
OCM biomarker documentation and reporting requirements did not appear to increase the proportions of patients with aNSCLC who underwent testing or who received biomarker-guided therapy in OCM versus non-OCM practices.
肿瘤护理模式（OCM）是医疗保险针对癌症患者的首个替代支付模式计划。截至 2017 年 10 月，参与的实践必须报告晚期非小细胞肺癌（aNSCLC）患者的生物标志物检测结果。我们的目的是评估这一 OCM 报告要求对护理质量的影响。
我们从全国范围内匿名电子健康记录衍生数据库中选择接受实践护理的 aNSCLC 患者。我们使用调整后的差异（DID）逻辑回归模型，比较 OCM 与非 OCM 实践中患者的生物标志物检测率（EGFR、ROS1 和 ALK）和接受生物标志物指导治疗的变化，在 OCM 实施前后。
分析包括 45 个 OCM 实践中的 14048 名患者（n=8151）和 105 个非 OCM 实践中的 5897 名患者。在研究期间（2011-2018 年），OCM 和非 OCM 实践中生物标志物检测和接受生物标志物指导治疗的总体未调整率均有所增加（分别为 55.5%至 71.6%；89.8%至 94.6%）。在调整后的 DID 模型中，生物标志物检测（比值比[OR]，1.09[95%CI，0.88 至 1.34]；=.45）和接受生物标志物指导治疗（OR，0.87[95%CI，0.52 至 1.45]；=.58）的比例在 OCM 和非 OCM 实践之间相似。
OCM 生物标志物文件记录和报告要求似乎并没有增加 OCM 与非 OCM 实践中接受测试或接受生物标志物指导治疗的 aNSCLC 患者的比例。
