Utilization of An NCI Infrastructure to Evaluate Breast Cancer Patient Outcomes of Importance in Determining Priorities for New Health Care Reform

摘要

This project continues to develop and refine a novel clinical curriculum that utilizes resources from diverse disciplines. I have combined sub-specialty training in oncology with formal courses in biostatistics, epidemiology, and health policy research, in order to develop expertise in clinical trials methodology and health care reform. The Clinical Research Scholars Program served as a foundation in outcomes research during the first year of the project. The second year of the project focused on an in depth analysis of high-dose chemotherapy with peripheral blood stem cell transplant as a treatment for breast cancer. Specifically, outcomes research methodology highlighted a comprehensive review of HDC for breast cancer, and compared this technology to other new treatments for breast cancer. Technology assessment serves a vital role the design of clinical pathways in an expanding managed care marketplace. Specific evidence-based guidelines were generated for Blue Cross/ Blue Shield of Michigan (BCBSM) in an attempt to clarify the controversy surrounding the investigational nature of HDC, and explore the impact of this new technology on practice patterns and 3rd-party payers coverage. During the final phase of the training grant a new Managed-Care oncology practice will be created at the University of California, San Francisco with particular emphasis on quality-of life and evidence-based practice guidelines. The goal is to incorporate outcomes assessment into a Managed Care marketplace.