老年癌症幸存者的共同照护与患者体验之间的关联。
Associations between shared care and patient experiences among older cancer survivors.
机构信息
Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, 20850, USA.
RTI International, Research Triangle Park, Durham, NC, 27709, USA.
出版信息
J Cancer Surviv. 2021 Apr;15(2):333-343. doi: 10.1007/s11764-020-00934-3. Epub 2020 Sep 18.
PURPOSE
Cancer survivors have unique medical care needs. "Shared care," delivered by both oncologists and primary care providers (PCPs), may better address these needs. Little information is available on differences in outcomes among survivors receiving shared care versus oncologist-led or PCP-led care. This study compared experiences of care for survivors receiving shared care, oncologist-led, PCP-led, or other care patterns.
METHODS
We used SEER-CAHPS data, including NCI's SEER registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses. Medicare Fee-for-Service beneficiaries age ≥ 65 years in SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey ≥ 18 months post-diagnosis were included. CAHPS measures included ratings of overall care, personal doctor, specialist physician, health plan, prescription drug plan, and five composite scores. Survivorship care patterns were identified using proportions of oncologist, PCP, and other physician encounters. Multivariable regressions examined associations between care patterns and CAHPS outcomes.
RESULTS
Among 10,132 survivors, 15% received shared care, 10% oncologist-led, 33% PCP-led, and 42% other. Compared with shared care, we found no significant differences in experiences of care except for getting needed drugs (lower scores for PCP-led and other care patterns). Sensitivity analyses using different patterns of care definitions similarly showed no associations between survivorship care pattern and experience of care.
CONCLUSIONS
Within the limitations of the study dataset, survivors age 65+ receiving shared care reported similar experiences of care to those receiving oncologist-led, PCP-led, and other patterns of care.
IMPLICATIONS FOR CANCER SURVIVORS
Shared care may not provide survivor-perceived benefits compared with other care patterns.
目的
癌症幸存者有独特的医疗需求。由肿瘤学家和初级保健提供者（PCP）共同提供的“共同照护”可能会更好地满足这些需求。关于接受共同照护、肿瘤学家主导的照护、PCP 主导的照护或其他照护模式的幸存者之间结局差异的信息有限。本研究比较了接受共同照护、肿瘤学家主导的照护、PCP 主导的照护或其他照护模式的幸存者的护理体验。
方法
我们使用了 SEER-CAHPS 数据，包括 NCI 的 SEER 登记数据、医疗保险索赔和医疗保险患者评估医疗保健提供者和系统（CAHPS）调查应答。SEER-CAHPS 中年龄≥65 岁的 Medicare 服务付费受益人与乳腺癌、宫颈癌、结直肠癌、肺癌、肾癌或前列腺癌或血液恶性肿瘤患者，在诊断后至少 18 个月对 Medicare CAHPS 调查做出应答，被纳入本研究。CAHPS 评估包括对总体护理、个人医生、专科医生、医疗计划、处方药计划以及五个综合评分的评价。使用肿瘤学家、PCP 和其他医生就诊的比例确定生存照护模式。多变量回归分析考察了照护模式与 CAHPS 结局之间的关联。
结果
在 10132 名幸存者中，15%接受共同照护，10%接受肿瘤学家主导的照护，33%接受 PCP 主导的照护，42%接受其他照护模式。与共同照护相比，我们发现除了获得所需药物外（PCP 主导和其他照护模式的评分较低），患者的护理体验没有显著差异。使用不同的照护模式定义的敏感性分析同样表明，生存照护模式与护理体验之间没有关联。
结论
在研究数据集的限制内，年龄≥65 岁接受共同照护的幸存者报告的护理体验与接受肿瘤学家主导的照护、PCP 主导的照护和其他照护模式的幸存者相似。
意义
对于癌症幸存者而言，与其他照护模式相比，共同照护可能不会提供幸存者感知的益处。
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