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.

项目概要/摘要 2017 年 9 月，飓风玛丽亚给波多黎各带来了前所未有的破坏。 波多黎各偏远地区的老年患者和居民承受了不成比例的影响，他们 医疗保健服务提供者和政策制定者目前正在寻求解决方案。 波多黎各的复苏概述了对波多黎各初级保健服务系统的重大投资 然而，波多黎各医生组织 (PO) 开展大规模初级保健的能力。 特别是，PO 的现有初级保健可能存在很大差异。 基础设施以及他们通常获得的实施新技术或财务支持的水平 来自其所属卫生系统或独立医师协会的基础设施， 来自与其签约的 Medicare Advantage 计划和 Medicaid 管理式医疗组织，或 拟议的研究以兰德公司之间的现有合作为基础。 和波多黎各大学将研究波多黎各医生组织的四种模式：联邦制 合格的卫生中心、小型独立医疗集团、大型独立医疗集团以及垂直医疗集团 我们将使用 Medicare 按服务付费索赔和 Medicare Advantage 遭遇。 用于评估通过这四种提供模式提供护理的医生队伍趋势的数据， 通过每种模式接受护理的医疗保险受益人，以及飓风后两种趋势的变化 然后，我们将评估前后的获取、护理质量和护理协调方面的变化。 飓风玛丽亚衡量不同 PO 模型的性能差异并识别高性能 PO 我们将采访 32 名表现最好的 PO 的领导者。 每个模型中的 PO 和表现最低的 PO 以确定他们拥有的先进初级保健基础设施 最后，我们将采访医疗保险生活受益人。 患有阿尔茨海默病（或阿尔茨海默病相关痴呆症）及其护理人员，以便更好地了解 他们未得到满足的护理需求以及这些需求在四种 PO 模型中有何不同。 并得到一个咨询委员会的支持，该委员会由两个当地提供商协会的代表组成， 代表老年人和阿尔茨海默病患者的两个当地患者倡导团体 该研究将有助于确定与阿尔茨海默病相关的痴呆症的具体模型。 与更高的性能相关，可以帮助指导波多黎各飓风玛丽亚的恢复 我们的研究结果还可以帮助利益相关者优先考虑最有可能扩展的特定服务。 直接改善阿尔茨海默病或阿尔茨海默病相关痴呆症患者的生活 他们的照顾者，并确定可能需要更多支持来解决当前差距的 PO 类型。