Niazi Shehzad K, Spaulding Aaron, Brennan Emily, Meier Sarah K, Crook Julia E, Cornell Lauren F, Ailawadhi Sikander, Clark Matthew M, Rummans Teresa A
Department of Psychiatry & Psychology.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and.
J Natl Compr Canc Netw. 2021 Mar 4;19(7):829-838. doi: 10.6004/jnccn.2020.7657.
It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers.
The 2017-2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)-level characteristics.
Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18-2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31-3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02-1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97-0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86-0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98-1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30-6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78-6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14-2.29) and had more beds (OR, 1.02; 95% CI, 1.01-1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88-0.97) was associated with decreased odds of offering CD services.
Patients' ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.
筛查并关注癌症患者的痛苦及心理社会需求是护理标准及认证要求。本研究评估了美国癌症中心心理健康（MH）和药物依赖（CD）服务的可及性。
使用2017 - 2018年美国医院协会（AHA）调查、区域卫生资源文件以及医疗保险和医疗补助服务中心医院比较数据库来评估服务的可及性以及与医院层面和卫生服务区域（HSA）层面特征的关联。
在接受调查的1144家癌症中心中，85.4%提供MH服务，45.5%提供CD服务；只有44.1%同时提供这两种服务。与提供MH服务的调整后几率增加相关的因素包括教学地位（优势比[OR]，1.76；95%置信区间[CI]，1.18 - 2.62）、作为医院系统的成员（OR，2.00；95% CI，1.31 - 3.07）以及拥有更多床位（每增加10张床位OR为1.04；95% CI，1.02 - 1.05）。较高的人口估计数（OR，0.98；95% CI，0.97 - 0.99）、较高的未参保百分比（OR，0.90；95% CI，0.86 - 0.95）以及HSA中较高的心理健康专业人员短缺区域水平（OR，0.99；95% CI，0.98 - 1.00）与提供MH服务的几率降低相关。与营利性中心相比，政府运营的中心（OR，2.85；95% CI，1.30 - 6.22）和非营利性中心（OR，3.48；95% CI，1.78 - 6.79）提供CD服务的几率增加。那些是医院系统成员（OR，1.61；95% CI，1.14 - 2.29）且床位更多（OR，1.02；95% CI，1.01 - 1.03）的中心提供这些服务的几率也增加。HSA中未参保患者的较高百分比（OR，0.92；95% CI，0.88 - 0.97）与提供CD服务的几率降低相关。
患者的支付能力、医院系统成员身份和机构规模可能是癌症中心内服务并置决策的驱动因素。尽管报销率较低，但较大的机构可能更有能力在经济上支持提供这些服务。专科支付模式的创新凸显了推动为高需求癌症患者提供MH和CD服务变革的机会。
