||5R21CA212687-02 Interpret this number
||Automated Delineation of Cancer Service Areas
For over 20 years, health care delivery in the U.S. has been informed by methodologies that create ?service areas?, such as
Hospital Service Areas (HSAs) of the Dartmouth Atlas Project, to evaluate how health care resources are distributed
across the population and how that impacts health outcomes. Policy makers have used these units to assess regional
variation in health care utilization and quality to design strategies for improving health and health care systems. Delivery
of cancer care in the United States represents a unique set of patients, technologies, clinical specialization, and patient-
centered perspectives, distinct from other patient populations. The Institute of Medicine and the American Society of
Clinical Oncology have recently noted that there is a ?crisis? in cancer care delivery, and highlighted the need for
meaningful ways to assess quality. We propose to develop a novel method to generate Cancer Service Areas (CSAs) ?
geospatial units analogous to HSAs, but specific to cancer care ? in order to create a framework for assessing regional
cancer care delivery, quality, and outcomes. Based on health care utilization captured through all-payer claims and
Medicare claims, we will extend and refine the Dartmouth HSA model. The derived CSAs have several key distinctions
from existing service area delineations: a) focus on cancer-specific patient population/diagnoses; b) inclusion of outpatient
claims, in addition to inpatient, to capture continuum of care; c) refinement of a complex network-based community
detection method to account for spatial patterns of patient care while attaining geographic contiguity of the CSAs; and d)
creation of an automated program in a Geographic Information Systems (GIS) environment that adapts to user-defined
sets of services, diagnoses, or clinical phenotypes. Our specific aims are to: 1) Develop Cancer Service Areas (CSAs)-
unique, cancer-specific geographic units of healthcare utilization to evaluate cancer care through a refined methodologic
approach; 2) Evaluate the CSAs versus Dartmouth HSAs to assess their spatial specificity to the population of interest;
and 3) Demonstrate the utility of CSAs as unique spatial units with respect to the cancer population. Creation of CSAs is
an urgent need for policymakers (e.g. Congress), decision leaders (e.g. ASCO), health care systems, and ultimately
patients who seek reliable, reportable information on quality cancer care. It is a first step towards these goals, and
promises to serve broad service area methodologies at the same time.
Evaluating breast cancer care coordination at a rural National Cancer Institute Comprehensive Cancer Center using network analysis and geospatial methods.
, Kapadia N.S.
, O'Malley A.J.
, Onega T.
Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2018-10-30 00:00:00.0; , .
Disparities in Geographic Accessibility of National Cancer Institute Cancer Centers in the United States.
, Fu C.
, Onega T.
, Shi X.
, Wang F.
Journal Of Medical Systems, 2017-11-11 00:00:00.0; 41(12), p. 203.