Project 1: Care Integration for Patients with Cancer Treated in Health Systems

Harvard Medical School, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT: Project 1 - This Project focuses on care integration for patients with cancer who are treated in vertically integrated health systems (i.e., organizations that own and operate hospitals and medical practices). Health systems are growing in the U.S., and understanding the conditions under which they effectively manage complex oncology care, which spans settings, sites and disciplines, is vital. Within a sample of practice sites owned by health systems, we will measure variation in non-structural forms of integration including: functional integration (e.g., having policies and protocols for coordination of care across settings), interpersonal integration (e.g., collaboration and teamwork within and across organizations), normative integration (e.g., common culture), and clinical process integration (e.g., activities intended to integrate care) and determine how they relate to care quality, utilization, and spending, overall and for patient subgroups, such as patients living in rural and low income areas. We also will evaluate how structural features (e.g. co-location, referral patterns, geographic reach) of system-owned practice sites relate to these non-structural forms of integration. Working with Projects 2, 3 and 4 and the Cores, the team will conduct case studies and interviews within health systems and their hospitals and practices. We will then collect representative data on integration measures with surveys from system leaders, practice managers, oncologists, surgeons, radiation oncologists, palliative care specialists, other clinicians, and practice staff. The team will use Medicare administrative data to describe key outcomes of cancer care, including quality of care, utilization, and spending, and assess the association of various forms of integration with these outcomes overall and for patient subgroups. The aims include: Aim 1. Adapt an existing conceptual framework to describe and develop measures of key forms of integration in health systems (i.e., structural, functional, normative, interpersonal, process) for oncology care delivered in health systems, using case studies and interviews. We will identify mechanisms through which distinct forms of integration may improve quality, utilization, and care delivery among patients served by health systems. Aim 2: Measure and assess care integration in health systems via surveys of practice leaders, clinicians, and staff. Assess how practice site, system (e.g., size, geographic reach) and market characteristics relate to non-structural forms of integration (functional, normative, interpersonal and process). Aim 3. After linking survey and claims data, assess the association of each form of integration with utilization, spending, and high-quality care for patients with cancer treated in health systems, and assess mechanisms through which integration improves or worsens care and outcomes overall and for subgroups such as patients living in rural areas and low-income areas.