Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria

飓风玛丽亚后波多黎各医生组织的初级保健转型

• 批准号: 10345390
• 负责人: Justin W. Timbie
• 金额: $ 77.58万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345390
• 关键词: Address; Advisory Committees; Alternative Health; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Caregivers; Caring; Cessation of life; Clinic; Collaborations; Complex; Contracts; Data; Disasters; Economics; Elderly; Eligibility Determination; Enrollment; Federal Government; Federally Qualified Health Center; Fee-for-Service Plans; Financial Support; Funding; Future; Geography; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hispanic Americans; Hospitals; Hurricane; Incentives; Infrastructure; Interview; Investments; Long-Term Care; Long-Term Effects; Low income; Managed Care; Measures; Medicaid; Medical; Medicare; Methods; Modeling; Organizational Models; Outcome; Patients; Performance; Physicians; Primary Care Physician; Primary Health Care; Protocols documentation; Provider; Puerto Rico; Quality of Care; Recording of previous events; Recovery; Research; Research Personnel; Resource-limited setting; Services; Shapes; Surgeon; System; United States Agency for Healthcare Research and Quality; Universities; Water; beneficiary; care coordination; care delivery; college; design; dual eligible; experience; food shortage; health care delivery; health care service; health care service organization; health disparity; health disparity populations; health plan; implementation barriers; improved; informal caregiver; interest; medical specialties; migration; older patient; patient advocacy group; payment; recruit; telehealth; trend

Project Summary/Abstract In September 2017, Hurricane Maria brought unprecedented devastation to Puerto Rico. The Hurricane’s impact was disproportionately borne by elderly patients and residents of remote areas of Puerto Rico who were vulnerable to disruptions in health care services. Providers and policymakers are currently seeking to make major investments in Puerto Rico’s primary care delivery system that were outlined in Puerto Rico’s recovery plan. However, the ability of Puerto Rico’s physician organizations (POs) to undertake large-scale primary care transformation remains unclear. In particular, POs might differ widely in both their existing primary care infrastructure as well as the level of technical or financial support they typically receive to implement new infrastructure from the health systems or independent physicians associations with which they are affiliated, from the Medicare Advantage plans and Medicaid managed care organizations with which they contract, or from the federal government. The proposed study, which builds on an existing collaboration between RAND and the University of Puerto Rico, will examine four models of physician organization in Puerto Rico: federally qualified health centers, small independent medical groups, large independent medical groups, and vertically- integrated medical groups. We will use Medicare fee-for-service claims and Medicare Advantage encounter data to assess trends in the physician workforce providing care through these four delivery models, the Medicare beneficiaries who receive care through each model, and changes in both trends following Hurricane Maria. We will then assess changes in access, quality of care, and care coordination before and after Hurricane Maria to measure differences in performance across PO models and to identify high-performing POs and low-performing POs in each model. We will conduct interviews with leaders of 32 of the highest-performing POs and lowest-performing POs in each model to identify the advanced primary care infrastructure they have sought to implement as well as implementation barriers. Finally, we will interview Medicare beneficiaries living with Alzheimer’s disease (or Alzheimer’s disease related dementias) and their caregivers to better understand their unmet care needs and how these needs differ across the four PO models. The research will be guided and supported by an Advisory Committee comprising representatives of two local provider associations and two local patient advocacy groups that represent older adults and people living with Alzheimer’s disease and Alzheimer’s disease related dementias. The study will help to identify specific models of physician organization that are associated with higher performance that could help guide Puerto Rico’s Hurricane Maria recovery effort. Our findings could also help stakeholders prioritize the expansion of specific services that could most directly improve the lives of patients with Alzheimer’s disease or Alzheimer’s disease related dementias and their caregivers and identify the types of POs that might need greater support to address current gaps.

项目摘要/摘要 2017年9月，玛丽亚飓风将前所未有的破坏带给了波多黎各。飓风 撞击是由古老的患者和波多黎各偏远地区的居民承担的 容易受到医疗服务中断的影响。提供者和政策制定者目前正在寻求制造 波多黎各的初级保健提供系统的重大投资，该系统在波多黎各的恢复中概述了 计划。但是，波多黎各的物理组织（POS）进行大规模初级保健的能力 转换仍然不清楚。特别是，POS在现有的初级保健中可能会有很大差异 他们通常会获得新的基础架构以及技术或财务支持水平 来自卫生系统或独立医师协会的基础设施 从医疗保险优势计划和与他们合同的医疗保健组织，或 来自联邦政府。拟议的研究基于兰德之间的现有合作 波多黎各大学将研究波多黎各的四种物理组织：联邦政府 合格的卫生中心，小型独立医疗团体，大型独立医疗团体以及垂直 综合医疗团体。我们将使用Medicare费用为服务索赔和Medicare Advantage遇到 通过这四个交付模型提供护理的物理劳动力趋势的数据， 通过每种型号获得照顾的医疗保险受益人，以及飓风之后的两种趋势的变化 玛丽亚。然后，我们将在之前和之后评估访问，护理质量和护理协调的变化 玛丽亚飓风衡量PO模型的性能差异并确定高性能的POS 和每个模型中表现低下的POS。我们将对32位表现最高的领导人进行访谈 POS和每个模型中表现最低的POS，以识别其具有的高级初级保健基础架构 试图实施和实施障碍。最后，我们将采访生活中的医疗保险受益人 阿尔茨海默氏病（或阿尔茨海默氏病有关的痴呆症）及其护理人员可以更好地了解 他们未满足的护理需求以及这些需求如何在四个PO模型中有所不同。研究将被指导 并得到一个咨询委员会的支持，该委员会完成代表两个地方提供商协会和 两个当地患者倡导组织，这些倡导组织代表老年人，并且患有阿尔茨海默氏病的人和 阿尔茨海默氏病有关的痴呆症。该研究将有助于确定身体组织的特定模型 与更高的性能有关的，这可能有助于指导波多黎各的飓风玛丽亚恢复 努力。我们的发现还可以帮助利益相关者优先考虑大多数服务的特定服务 直接改善阿尔茨海默氏病或​​阿尔茨海默氏病有关的患者的生活 他们的护理人员并确定可能需要更大支持以解决当前差距的POS类型。