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首页> 外文期刊>Cancer: A Journal of the American Cancer Society >Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care
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Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care

机译：Medicare的早期效果共享储蓄计划责任护理组织参与前列腺癌症护理

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BACKGROUND Accountable care organizations (ACOs) can improve prostate cancer care by decreasing treatment variations (ie, avoidance of treatment in low‐value settings). Herein, the authors performed a study to understand the effect of Medicare Shared Savings Program ACOs on prostate cancer care. METHODS Using a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer from 2010 through 2013. Rates of treatment, potential overtreatment (ie, treatment in men with a ≥75% chance of 10‐year mortality from competing risks), and Medicare payments were measured using regression models. The impact of ACO participation was assessed using difference‐in‐differences analyses. RESULTS Before implementation of ACOs, the treatment rate was 71.8% (95% confidence interval [95% CI], 70.2%‐73.3%) for ACO‐aligned beneficiaries and 72.3% (95% CI, 71.7%‐73.0% [ P ?=?.51]) for non‐ACO‐aligned beneficiaries. After implementation, this rate declined to 68.4% (95% CI, 66.1%‐70.7% [ P ?=?.017]) for ACO‐aligned beneficiaries and 69.3% (95% CI, 68.5%‐70.1% [ P .001]) for non‐ACO‐aligned beneficiaries. There was no differential effect noted for ACO participation. The rate of potential overtreatment decreased from 48.2% (95% CI, 43.1%‐53.3%) to 40.2% (95% CI, 32.4%‐48.0% [ P ?=?.087]) for ACO‐aligned beneficiaries and increased from 44.3% (95% CI, 42.1%‐46.5%) to 47.0% (95% CI, 44.5%‐49.5% [ P ?=?.11]) for non‐ACO‐aligned beneficiaries. These changes resulted in a significant relative decrease in overtreatment of 17% for ACO‐aligned beneficiaries (difference‐in‐differences, 10.8%; P ?=?.031). Payments were not found to be differentially affected by ACO alignment. CONCLUSIONS The treatment of prostate cancer and annual payments decreased significantly between 2010 and 2013, but ACO participation did not appear to impact these trends. Among men least likely to benefit, Medicare Shared Savings Program ACO alignment was associated with a significant decline in prostate cancer treatment. Cancer 2018;124:563‐70 . ? 2017 American Cancer Society .
机译：背景技术责任护理组织（ACOS）可以通过降低治疗变异来改善前列腺癌护理（即避免在低价设置中的治疗）。在此，作者进行了一项研究，了解Medicare共享节约计划ACO对前列腺癌护理的影响。方法采用20％Medicare样品，作者鉴定了2010年至2013年新诊断的前列腺癌的男性。治疗率，潜在的过处（即，男性的治疗≥75％的竞争风险的10年死亡率的可能性≥75％），使用回归模型测量Medicare付款。使用差异差异分析评估ACO参与的影响。结果在实施ACOS之前，治疗率为71.8％（95％置信区间[95％CI]，70.2％-73.3％），用于72.3％（95％CI，71.7％-73.0％[P？对于非ACO对齐的受益人，=Δ.51]。实施后，该速率下降至68.4％（95％CI，66.1％-70.7％，用于ACO对齐的受益剂和69.3％（95％CI，68.5％-70.1％[P＆ .001]）对于非ACO对齐的受益人。 ACO参与没有差异效果。潜在过度处理的速度从48.2％（95％CI，43.1％-53.3％）降至40.2％（95％CI，32.4％-48.0％[P？=〜087]），用于ACO-对齐的受益人并增加对于非ACO-Anigard受益者，44.3％（95％CI，42.1％-46.5％）至47.0％（95％CI，44.5％-49.5％[p？=β.11]）。这些变化导致过度处理的17％的显着相对降低（差异差异，10.8％; p？= 031）。未发现支付差异化受ACO对准的影响。结论2010年至2013年，前列腺癌及年度付款的治疗减少，但ACO参与似乎没有影响这些趋势。在最不可能受益的男性中，Medicare共享节约计划ACO对准与前列腺癌治疗的显着下降有关。癌症2018; 124：563-70。还2017年美国癌症协会。

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