MARKET BASED REFORMS AND QUALITY OF CARE

基于市场的改革和护理质量

• 批准号: 6599647
• 负责人: EDWARD GUADAGNOLI
• 金额: $ 8.86万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-07-01 至 2003-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6599647
• 关键词: Medicare /Medicaid; angiography; behavioral /social science research tag; catheterization; clinical research; gastrointestinal hemorrhage; gastrointestinal surgery; health care cost /financing; health care policy; health care quality; health care service evaluation; health services research tag; heart disorder chemotherapy; heart revascularization; heart surgery; human data; human mortality; managed care; myocardial infarction; outcomes research; patient care management; pulmonary circulation obstruction; relapse /recurrence; respiratory surgery; shock; statistics /biometry

Description: This project will have two sub-projects. In the first, they will the examine role of market forces - managed care penetration - in the appropriate use of angiography and drug treatment for Medicare patients with AMI. They will also examine managed care penetration and mortality and reinfarction. This project will use data from Cooperative Cardiovascular Project, Baker?s market designations, a modified version of the RAND appropriateness instrument, and concordance with a guideline for drug therapy. They will employ a two step hierarchical model, with the first being a patient level and the second a market level. By using a more extensive set of covariates, they will have better case-mix adjustment than other studies have had. In the second project, they will look at quality and outcomes of care for shock, acute GI bleed, pulmonary embolus, and AMI as competition changed in New Jersey following the 1992 of New Jersey's rate setting approach. New York will act as a control state. HCUP data will be used. They will examine cardiac catheterization and cardiac revascularization for patients with AMI, endoscopy for GI bleeds, pulmonary angiograms for patients with embolisms. In each case the object of study is the rate or likelihood, not its appropriateness. Outcomes will include mortality. The advantages of these four conditions is that they are exclusively treated in an inpatient setting - if the patient makes it that far. Thus, there should be no selection issues caused by lower likelihood of hospitalization or switching care to outpatient settings under more stringent health care plans. The second project is basically a before and after comparisons with a contemporaneous control group to capture secular trends.

描述：该项目将有两个子项目。首先，他们 审查市场力量的作用 - 管理护理渗透 - 适当使用用于医疗保险患者的血管造影和药物治疗 ami。他们还将检查管理的护理渗透和死亡率 重新灌溉。该项目将使用合作心血管的数据 项目，贝克的市场名称，兰德的修改版本 适当工具，并与药物治疗指南一致。 他们将采用两个步骤的分层模型，第一个是病人 水平和第二个市场水平。通过使用一组更广泛的 协变量，它们的病例调整将比其他研究具有更好的病例调整 有。 在第二个项目中，他们将研究质量和护理结果 随着竞争的变化，震动，急性GI出血，肺栓塞和AMI 在1992年新泽西州的利率设定方法之后，新泽西州。纽约 将充当控制状态。将使用HCUP数据。他们将检查 AMI患者的心脏导管和心脏血运重建 胃肠道出血的内窥镜检查，栓塞患者的肺血管造影。在 每种情况研究的目的都是速率或可能性，而不是 适当性。结果将包括死亡率。 这四个条件的优点是它们被专门处理 在住院环境中 - 如果患者做到这一点。因此，应该在那里 没有较低的住院可能性或 在更严格的医疗保健计划下，将护理切换到门诊环境。 第二个项目基本上是与 同时对照组捕获世俗趋势。