旨在检查妇科癌症患者中责任医疗组织 (ACO) 泄漏的模式，即指定 ACO 的患者从指定的 ACO 网络之外的机构接受医疗保健的情况。 ACO 泄漏被估计为在其 ACO 分配之外寻求护理的患者的比率。确定了与 ACO 渗漏相关的因素，并描述了癌症诊断第一年内的成本差异。Medicare 5% 数据（2013-2017 年）用于量化具有稳定 ACO 分配的妇科癌症患者的渗漏率。使用对数二项式回归模型估计 ACO 泄漏风险因素的粗略风险比和多变量调整风险比。使用 Wilcoxon 秩和检验比较按 ACO 泄漏状态划分的总体支出差异和癌症特异性支出差异。ACO 泄漏的总体发生率为 28.1%，其中门诊护理和子宫癌患者的泄漏率最高。与白人患者相比，黑人患者的 ACO 泄漏风险高出 56%，而家庭收入中位数较高的患者与最低五分之一的患者相比，ACO 泄漏风险高出 77%。随着 ACO 规模和专科医生数量每增加一个单位，泄漏率分别减少 3% 和 8%。渗漏患者的医疗费用高出 19.5%。 妇科癌症患者的 ACO 渗漏率总体上较低，存在一些区域和时间差异，某些亚组的渗漏率较高，并且住院和门诊患者中 ACO 渗漏患者的医疗保险支出显着较高。这些发现确定了进一步调查的目标和策略，以鼓励肿瘤学家参与 ACO 并防止因使用非 ACO 提供者而增加医疗保健成本。版权所有 © 2024。由 Elsevier Inc. 出版。

To examine patterns of Accountable Care Organizations (ACO) leakage, the receipt of healthcare by ACO-assigned patients from institutions outside assigned ACO network, among patients with gynecologic cancer. ACO leakage was estimated as rates of patients seeking care external to their ACO assignment. Factors associated with ACO leakage were identified and cost differences within the first year of cancer diagnosis described.Medicare 5% data (2013-2017) was used to quantify rates of leakage among gynecologic cancer patients with stable ACO assignment. Crude and multivariable adjusted risk ratios of ACO leakage risk factors were estimated using log-binomial regression models. Overall and cancer-specific spending differences by ACO leakage status were compared using Wilcoxon rank-sum test.Overall incidence of ACO leakage was 28.1% with highest leakage for outpatient care and uterine cancer patients. ACO leakage risk was 56% higher among Black relative to White patients, and 77% more for those in higher relative to lowest quintiles of median household income. Leakage decreased by 3% and 8% with each unit increase in ACO size and number of subspecialists, respectively. Healthcare costs were 19.5% higher for leakage patients.ACO leakage rates among gynecologic cancer patients was overall modest, with some regional and temporal variation, higher leakage for certain subgroups and substantially higher Medicare spending in inpatient and outpatient settings for patients with ACO leakage. These findings identify targets for further investigations and strategies to encourage oncologists to participate in ACOs and prevent increased health care costs associated with use of non-ACO providers.Copyright © 2024. Published by Elsevier Inc.