title: The effects of managed care and competition on community-based clinical research.
abstract: BACKGROUND
  The National Institutes of Health is developing practice-based clinical research networks (PBRNs) to expedite the pace of scientific discovery and improve care quality. Anecdotal evidence suggests managed care penetration and provider competition negatively affect PBRN clinical research.
  
  
  OBJECTIVE
  The objective of this study is to examine the effects of environmental factors on clinical research performance in the National Cancer Institute's Community Clinical Oncology Program (CCOP).
  
  
  METHODS
  This study examined 49 CCOPs in 34 states using longitudinal (1991-2001) generalized least-squares regression including fixed effects, using secondary data from the National Cancer Institute, Group Health Association of America, InterStudy, American Hospital Association, Area Resource Files, and the Current Population Survey.
  
  
  METHODS
  Performance was measured as CCOP-level accrual in treatment trials, cancer prevention and control (CP/C) trials, and all trials combined. HMO penetration served as a proxy for managed care penetration. Competition measures included both hospital competition and physician competition.
  
  
  RESULTS
  Managed care penetration was positively associated with accrual in areas of low to moderate penetration and negative in the areas of high penetration. Compared with areas with 5% penetration, areas with 15% penetration had 21% more treatment accrual and 66% more CP/C accrual. Compared with areas with 40% penetration, areas with 50% penetration had 11% lower treatment accrual and 3% lower CP/C accrual. CP/C accrual was more positively affected than treatment accrual. Greater hospital competition was associated with a decline in trial enrollment.
  
  
  CONCLUSIONS
  The healthcare environment appears to have a significant effect on accrual into community-based cancer treatment and CP/C clinical trials. Findings for treatment and CP/C accrual suggest each type of accrual is distinct and requires different strategies and administrative methods.
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. wrc4@email.unc.edu
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Arnold D
authors.initials: AD
authors.lastname: Kaluzny
authors.forename: Marisa Elena
authors.initials: ME
authors.lastname: Domino
authors.forename: Shoou-Yih Daniel
authors.initials: SY
authors.lastname: Lee
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods*; D003153:Community Health Services / Q000458:organization & administration*; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D008137:Longitudinal Studies; D009316:National Institutes of Health (U.S.); D009369:Neoplasms / Q000628:therapy*; D012044:Regression Analysis; D014481:United States; D014495:Universities / Q000458:organization & administration