Shih Ya-Chen Tina, Xu Ying, Lowenstein Lisa M, Volk Robert J
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
MDM Policy Pract. 2021 Jan 27;6(1):2381468320984773. doi: 10.1177/2381468320984773. eCollection 2021 Jan-Jun.
The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 ( < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 ( < 0.0001). Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.
医疗保险和医疗补助服务中心在其针对肺癌筛查（LCS）的低剂量计算机断层扫描（LDCT）覆盖政策中要求有一份关于共同决策（SDM）就诊的书面医嘱。鉴于筛查资格从55岁开始，私人保险计划可能会采用这一覆盖政策。本研究考察了在有私人保险的人群中，肺癌筛查背景下共同决策的实施情况。我们从2016 - 2017年市场扫描商业理赔与诊疗数据库中构建了两个研究队列：一个是接受肺癌筛查低剂量计算机断层扫描的低剂量计算机断层扫描队列，另一个是进行了与肺癌筛查相关共同决策就诊的共同决策队列。对于低剂量计算机断层扫描队列，我们研究了在低剂量计算机断层扫描前3个月内接受共同决策的趋势及相关因素。对于共同决策队列，我们研究了共同决策就诊后3个月内进行低剂量计算机断层扫描的趋势及相关因素。对于年龄小于64岁的有私人保险的成年人，低剂量计算机断层扫描队列中有93%（19,681/21,084）没有表明进行了共同决策的计费索赔，尽管共同决策的采用率从2016年第一季度的3.1%上升到了2017年第四季度的8.2%（P<0.0001）。对于共同决策队列，46%（948/2048）在共同决策就诊后的3个月内没有肺癌筛查低剂量计算机断层扫描的索赔；这一比例从2016年第一季度的29.5%上升到了2017年第三季度的61.8%（P<0.0001）。研究结果不能推广到其他没有私人保险的非老年成年人。此外，从索赔中确定的共同决策率可能被低估。我们发现，在接受低剂量计算机断层扫描的有私人保险的个体中，共同决策的采用率虽在上升但仍较低。共同决策队列中的低剂量计算机断层扫描率高于全国研究报告的比率，这强调了患者意识的重要性。
