Outcomes and Costs Associated with Frequency of Physician-Patient Visits on Hemod

与 Hemod 治疗的医患就诊频率相关的结果和成本

基本信息

批准号：
7894011
负责人：
Areef Ishani
金额：
$ 31.06万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-06-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7894011
关键词：
Achievement Address Age Capitation Fee Caring Characteristics Clinical Code Congresses Cost Analysis Cost Savings Cost of Illness Data Data Set Diabetes Mellitus Diabetic Retinopathy Dialysis patients Dialysis procedure Employment Status End stage renal failure Epidemiologic Methods Erythropoiesis Etiology Expenditure Fees Frequencies Future Glycosylated hemoglobin A Goals Health Health Policy Health Services Hemodialysis Hemoglobin Hospital Costs Hospitalization Hospitals Incentives Individual Influenza Inpatients Institution International Intervention Intravenous Iron Kidney Transplantation Knowledge Laboratories Link Lipids Location Medicare Medicare claim Methods Morbidity - disease rate Observational Study Outcome Outcomes Research Outpatients Parathyroid hormone measurement Patients Performance Physicians Policies Prevalence Principal Investigator Process Measure Quality of Care Race Radiology Specialty Randomized Controlled Trials Registries Reporting Research Research Personnel Risk Rural Screening procedure Services Socioeconomic Status Statistical Methods Structure Testing Time Training United States United States Centers for Medicare and Medicaid Services Urea Vaccinated Visit Vital Statistics Vitamin D Waiting Lists base capitate bone cost cost effective cost effectiveness diabetic experience follow-up improved innovation interest medical schools medical specialties mortality payment programs public health relevance residence sex

项目摘要

DESCRIPTION (provided by applicant): Individuals with end-stage kidney disease (ESKD) have exceedingly high morbidity and mortality rates. In January 2004, in an attempt to improve patient outcomes, the Centers for Medicare & Medicaid Services (CMS) linked physician reimbursement for outpatient hemodialysis care to the number of monthly physician - patient visits on dialysis, thereby stimulating more frequent physician - patient contact. The new reimbursement policy resulted in increased visit frequency between physicians and their hemodialysis patients, but the effect of this increased visit frequency on patients' outcomes and costs remains unknown. We aim to determine the association between physician-patient visit frequency and outcomes and costs among incident hemodialysis patients. This proposal outlines the use of several national datasets that include patient, physician, and dialysis facility characteristics, reliable vital statistic ascertainment, as well as longitudinal Medicare inpatient and outpatient claims data to efficiently evaluate the association between physician - patient visit frequency and patient outcomes and costs. We hypothesize that greater physician-patient visit frequency is associated with a reduced patient hospitalization and mortality rate, greater achievement of dialysis clinical performance targets, greater utilization of preventative services, and greater Medicare expenditures. Our specific aims are as follows: To determine the association between increased physician-patient visit frequency and hospitalization and mortality rates among incident hemodialysis patients; To determine the association between increased physician-patient visit frequency and the achievement of dialysis clinical performance targets, dialysis process measures and utilization of preventative services; To determine whether the association between physician-patient visit frequency and patient health outcomes is altered by select patient, physician, and dialysis facility characteristics; To determine if increased physician-patient visit frequency is associated with higher Medicare expenditures; and to determine the incremental cost-effectiveness ratio of four or more physician-patient visits per month compared to fewer monthly visits. The proposed study will have a significant impact irrespective of findings as the first study to evaluate, on a national level, the relationship between physician-patient visit frequency and outcomes and to provide much-needed evidence for future policy changes related to frequency of visits between physicians and their patients. PUBLIC HEALTH RELEVANCE: Strategies directed at providing efficient and cost-ffective care while improving outcomes in patients with ESKD are urgently needed. We aim to determine if greater physician-patient contact frequency among incident hemodialysis patients improves patient health outcomes and influences the cost of providing care to those on dialysis. The research proposed will have significant impact, irrespective of findings. If increased physician-patient visit frequency on hemodialysis is found to improve health outcomes, frequent follow-up should become standard practice for all dialysis patients, and future Medicare reimbursement policies can further strengthen incentives for greater physician- patient visit frequency on dialysis. Alternatively, if increased patient-physician visit frequency does not influence health outcomes but significantly increases Medicare expenses, a randomized controlled trial should be conducted to determine if frequency of physician-patient visits on dialysis alters patient outcomes. Should the trial verify these findings, the current CMS policy should be revised, potentially leading to significant cost savings.

描述（由申请人提供）：患有末期肾脏疾病（ESKD）的人的发病率和死亡率极高。 2004年1月，为了改善患者的预后，医疗保险和医疗补助服务中心（CMS）相关的医师报销以提供门诊血液透析护理与每月医师的数量 - 患者透析的访问，从而刺激更常见的医生 - 患者 - 患者接触。新的报销政策导致医生及其血液透析患者之间的访问频率增加，但是这种访问频率增加对患者结果和成本的影响仍然未知。我们旨在确定医师患者访问频率与结果与成本之间的关联。该提案概述了包括患者，医师和透析设施特征，可靠的重要统计确定性以及纵向医疗保险住院和门诊索赔数据的几个国家数据集的使用，以有效地评估医师的关联 - 患者就诊频率和患者的成果和患者的成果和成本。我们假设更大的医师访问频率与患者住院率降低和死亡率降低有关，透析临床绩效目标的更大实现，预防服务的更大利用以及更多的医疗保险支出。我们的具体目的如下：确定出现血液透析患者的医师访问频率和住院频率和死亡率增加之间的关联；为了确定医生访问频率增加与透析临床性能目标，透析过程指标和预防服务的利用之间的关联；确定某些患者，医师和透析设施的特征是否会改变医师访问频率和患者健康结果之间的关联；确定增加的医生访问频率是否与更高的医疗保险支出有关；并确定每月四次或更多医师患者访问的增量成本效益比率与较少的每月访问相比。拟议的研究将产生重大影响，而不论发现是第一个在国家一级评估医师患者访问频率和结果之间的关系，并为未来的政策变化提供与医生及其患者之间的访问频率有关的证据。公共卫生相关性：迫切需要迫切需要提供高效且具有成本性的护理的策略，同时迫切需要改善ESKD患者的结局。我们旨在确定事件血液透析患者的医师接触频率是否更大，可以改善患者的健康状况，并影响为透析患者提供护理的成本。提出的研究将产生重大影响，而不论发现。如果发现在血液透析上增加医生访问频率可以改善健康状况，那么频繁的随访应成为所有透析患者的标准练习，并且未来的Medicare报销政策可以进一步增强医生的激励措施，以使医生的透析频率更大。或者，如果增加患者 - 医学家的访问频率不会影响健康结果，而是显着增加医疗保险费用，则应进行一项随机对照试验，以确定透析上医生患者访问的频率是否改变了患者的结果。如果审判验证这些发现，应修改当前的CMS政策，并有可能导致大量成本节省。