Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD.
Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.
JCO Oncol Pract. 2023 Jan;19(1):e33-e42. doi: 10.1200/OP.22.00304. Epub 2022 Dec 6.
Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited.
Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups.
The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, -8.0 to -5.3) and 4.7% (95% CI, -6.3 to -3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, -14.1 to -12.2) lower for rural residents compared with urban; 10.4% (95% CI, -11.2 to -9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, -17.5 to -15.8) lower for colorectal compared with breast cancer.
Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.
60%的成年人在癌症诊断时患有多种慢性病。这些患者可能需要一个多学科临床团队，即多团队系统（MTS），涉及多个专科医生和初级保健医生，他们理想情况下应协调临床责任、共享信息并调整临床决策，以确保全面管理医疗需求。然而，使用美国人群水平数据检查癌症诊断时患有多种合并症的个体的 MTS 组成和复杂性的相关见解有限。
我们使用 SEER-Medicare 数据（2006-2016 年），确定了新诊断患有乳腺癌、结直肠癌或肺癌且伴有心肺疾病和/或糖尿病合并症的患者（n=75201）。使用 Zaccaro 的基于理论的 MTS 分类方法，将癌症诊断后 4 个月内的临床 MTS 复杂性分为高复杂性（≥4 名来自≥2 个专业的临床医生）和低复杂性（1-3 名来自 1-2 个专业的临床医生）。我们描述了不同 MTS 组成的患者比例，并按患者群体量化了高复杂性 MTS 护理的发生率。
最常见的 MTS 组成是肿瘤学与初级保健相结合（37%）。有一半（50.3%）患者接受了高复杂性 MTS 护理。非西班牙裔黑人患者和西班牙裔患者的癌症高复杂性 MTS 护理发生率比非西班牙裔白人患者低 6.7%（95%CI，-8.0 至-5.3）和 4.7%（95%CI，-6.3 至-3.0）；农村居民比城市居民低 13.1%（95%CI，-14.1 至-12.2）；双重 Medicaid-Medicare 受益人与仅 Medicare 受益人相比低 10.4%（95%CI，-11.2 至-9.5）；与乳腺癌相比，结直肠癌患者低 16.6%（95%CI，-17.5 至-15.8）。
在来自服务不足人群的患有多种慢性病的癌症患者中，观察到高复杂性 MTS 护理的发生率存在差异。结果强调需要进一步了解护理团队组成、复杂性和功能如何影响护理质量和结果的作用和机制。
