Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    Mental illness has become more common over the last decade, particularly among 18- to 25-year-olds. This Data Insights looks at trends in mental health and their implications for the future.

    Learn More
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

    Learn More
  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Does Practice Setting Affect Care Provided to Patients with Advanced Cancer?

Why This Study Is Important

The ongoing shift in oncology outpatient care from independent physicians’ offices to hospital outpatient departments (HOPDs) raises the question of how practice setting affects oncologists’ treatment patterns and the quality of cancer care. This study examines site-of-care differences in the use of low-value therapies and supportive care drugs, use of hospital and emergency departments (EDs) for unmanaged symptoms of chemotherapy, and use of hospice care for patients with advanced cancer.

What This Study Found

  • Patients receiving chemotherapy in independent physicians’ offices were more likely to be given low-value supportive care drugs. Compared to patients treated in HOPDs, patients treated in offices were 72 percent more likely to receive ESAs and 28 percent more likely to receive G-CSF.
  • Patients with advanced breast cancer were also somewhat more likely to receive low-value chemotherapy when treated in physicians’ offices, but these differences were not statistically significant after controlling for patient characteristics.
  • Bevacizumab was rarely used for patients with advanced squamous NSCLC in either physicians’ offices or HOPDs, indicating appropriate care in both settings for this population.
  • Use of hospitals and EDs for chemotherapy-related complications and use of hospice care did not differ according to whether the patient was treated in a physician’s office or an HOPD.

What These Findings Mean

The finding that oncologists in independent offices prescribed certain low-value cancer drugs more often than their colleagues in HOPDs points to a need to better understand the mechanisms through which practice setting could influence physicians’ behavior. Financial incentives are one possible driver of behavior and would be likely to affect physicians in private offices more directly than HOPD physicians. Payment reforms that better align incentives with best practices in clinical care may help to improve the value of office-based care. Physicians in HOPDs may also have the benefit of supportive organizational cultures, including ongoing education and peer-to-peer learning. Similar educational efforts could be helpful for office-based physicians.

More About This Study

This study used Medicare claims linked with SEER cancer registry data to identify Medicare beneficiaries newly diagnosed at Stage IV with any of six types of cancer between 2004 and 2011. Use of two low-value supportive care drugs – erythropoiesis-stimulating agents (ESAs) and white cell stimulating factors (G-CSF) – was identified for all patients, along with any chemotherapy-related inpatient admissions or ED visits and hospice services. For patients with breast cancer, use of two types of low-value chemotherapy regimens was examined: a combination of any two cytotoxic chemotherapies within 30 days and first or only use of nab-paclitaxel among patients receiving a taxane chemotherapy agent. For patients with squamous non-small cell lung cancer (NSCLC), use of bevacizumab was also assessed; this drug is not approved for this subpopulation. Patients were assigned to a practice setting based on the site of their first chemotherapy administration. Logistic regression with hierarchical modeling was used to examine site differences in the probability of receiving each study service.

Full Citation

Lipitz-Snyderman A, Atoria CL, Schleicher SM, Bach PB, and Panageas KS. “Practice Patterns for Older Adult Patients Presenting with Advanced Cancer: Physician Office versus Hospital Outpatient Department.” Journal of Oncology Practice, published online December 13, 2018.

For more information about this study, contact Dr. Allison Lipitz-Snyderman at This email address is being protected from spambots. You need JavaScript enabled to view it..
For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Dr. Julie Schoenman at 202-296-4426.

Learn More

This Research Insights highlights a study showing that certain low-value cancer drugs are more likely to be prescribed in independent physician practices.

Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

Read More


NYTUpshotLogo

Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

Read More

Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

Read More