PROJECT SUMMARY/ABSTRACT: Project 3 - Care Integration for Patients Receiving Post-Acute Care and Hospice This Project focuses on care integration for patients with cancer who are treated in post-acute (skilled nursing facilities, inpatient rehabilitation facilities, and home health) and hospice settings. Care for patients with cancer at the end-of-life is often fragmented and not patient-centered, particularly among marginalized populations. Less is known about the coordination and quality of post-acute care for patients undergoing complex cancer surgeries and hospitalizations for disease- and treatment-related complications. There has been substantial consolidation in post-acute care and hospice settings, including a marked increase in the prevalence of for- profit chains. Structural integration across sectors (e.g., with systems/hospitals) could increase other forms of integration, such as: functional (e.g., policies and protocols for coordination of care across settings), normative (e.g., common culture), interpersonal (e.g., collaboration and teamwork within and across organizations), and clinical process integration (e.g., activities integrating services across settings). Alternatively, such structural integration could increase incentives for referrals to lower-quality facilities, service or staffing reductions, or employment of less skilled clinical staff. Working with Projects 1, 2, and 4 and the Cores, the team will conduct case studies and interviews of clinicians within health systems and their hospitals and practices as well as clinicians and staff in post-acute care and hospice settings to evaluate how structural features (e.g. co-location, referral patterns, geographic reach) relate to these other non-structural forms of integration. The team will survey medical and nursing directors, clinicians, and staff from a random sample of post-acute and hospice facilities that do not have ownership arrangements with health systems to measure non-structural forms of integration outside of health systems. The team will use administrative data from Medicare, Medicaid, and commercial insurers to describe key outcomes, such as utilization (e.g. readmissions), spending, and high quality and equitable care (e.g., post-operative complications, patient/family experiences), and to examine associations between integration types and outcomes overall and for marginalized populations. The aims are: Aim 1: Adapt an existing framework to describe key forms of integration (i.e., structural, functional, normative, interpersonal, and process) for the care of oncology patients in post-acute care and hospice settings and identify mechanisms through which forms of care integration may produce improved outcomes and more equitable care for patients using post-acute and hospice care. Aim 2: Measure care integration in post-acute care and hospice settings and assess relationships among different forms of care integration. Determine how these relationships vary by ag...