Time, Referrals, And Doctoring???Efficient Options For the Future (TRADEOFF)

时间、转诊和就诊？？？未来的有效选择（权衡）

基本信息

批准号：
8337824
负责人：
HAROLD S LUFT
金额：
$ 11.33万
依托单位：
PALO ALTO MEDICAL FOUNDATION RES INST
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8337824
关键词：
Address Adopted Behavior CCL4 gene Caring Categories Clinical Data Decision Making Diagnosis Dimensions Economics Electronic Health Record Expenditure Fee Schedules Fee-for-Service Plans Feedback Financial compensation Formularies Foundations Future Group Practice Healthcare Healthcare Systems Image Incentives Information Systems Insurance Leadership Mails Measurement Measures Medical Medicine Metric Modification Morals Office Visits Outcome Outpatients Output Patient Outcomes Assessments Patients Physicians Population Price Primary Care Physician Primary Health Care Process Provider Quality Indicator Quality of Care Reality Testing Recommendation Relative (related person)Reporting Research Research Project Grants Resources Rewards Risk Adjustment Science Services Site Specialist Speed Structure Suggestion System Telephone Testing Time Touch sensation Uncertainty Ursidae Family Variant Visit base clinical care cost design experience flexibility hazard improved medical specialties payment response service utilization

项目摘要

DESCRIPTION (provided by applicant): This R-21 project explores whether time spent by primary care physicians (PCPs) both in face-to-face office visits and out-of-office efforts may substitute for (a) services they directly order, such as tests, imaging, and referrals to specialists, and/or (b) services their patients may access directly from other PCPs, specialists, and urgent care settings. Current fee schedules reward PCPs relatively poorly for the time they spend in face- to-face visits, but rarely for out-of-office "touches" such as phone calls and e-messaging recorded in the patient's chart, and not at all for other time and effort that reduce the use of other costly services. "Bending the cost curve" will require less resource use, not just lower prices for resources. Lowering expenditures, however, is politically unacceptable if it reduces quality. We examine both clinical quality indicators and patient assessments of their care to see if they are comparable between PCPs whose patients consume many resources relative to those consuming fewer resources. Data will be drawn from the Palo Alto Medical Foundation (PAMF), a large multispecialty group practice with nearly 1000 physicians in 46 sites. PAMF approximates a microcosm of the US healthcare system in important ways-its physicians are paid on a FFS basis, there is a wide variety of insurance type and coverage, no fixed formulary, and physicians have substantial flexibility in their practice. PAMF's data systems, however, facilitate complete capture of all clinical activities, detailed risk adjustment, measurement of PCP time in the office and using the electronic health records out of the office, and routine reporting of quality metrics and patient assessments. This allows for the rapid completion of the project. Speed is important because providers will be forming and implementing Accountable Care Organizations (ACOs) by 2012. ACOs are predicated on changing physician behavior to encourage less costly approaches to care. Little is known, however, about how to compensate physicians within ACOs to reward more efficient use of resources yet maintain or improve quality of care. Our empirical findings will inform the design of modifications to fee schedules that can be adopted by ACOs. PAMF is examining how to structure itself as an ACO so its leadership will assess the feasibility of our proposals, providing a "reality test" of our recommendations before they are widely disseminated.

描述（由申请人提供）：该R-21项目探讨了在面对面的办公室访问和户外工作中花费的时间（PCP）是否可以代替（a）直接点订购的服务，例如测试，成像和转介专家，以及/或（b）对患者的患者服务可能直接从其他PCP，专家，专家，专家，迫切的专家访问。当前的费用时间表在他们在面对面访问中花费的时间相对较差，但很少出现在病人图表中记录的电话和电子通用的临时“触摸”，而不是在其他时间和精力上减少其他昂贵服务的使用。 “弯曲成本曲线”将需要更少的资源使用，而不仅仅是降低资源的价格。但是，如果降低支出会降低质量，则在政治上是不可接受的。我们检查了临床质量指标和患者对其护理的评估，以查看他们是否相对于消耗较少资源的患者消耗了许多资源的PCP之间的可比性。数据将来自帕洛阿尔托医学基金会（PAMF），这是一个大型多专业小组实践，在46个地点中有近1000名医生。 PAMF以重要的方式近似于美国医疗保健系统的缩影。但是，PAMF的数据系统有助于完全捕获所有临床活动，详细的风险调整，办公室中PCP时间的测量以及使用办公室外的电子健康记录以及质量指标和患者评估的常规报告。这允许项目快速完成。速度很重要，因为提供者将于2012年成立和实施负责任的护理组织（ACO）。ACOS的基础是改变医师行为，以鼓励降低成本的护理方法。然而，关于如何补偿ACO中的医生以奖励更有效利用资源但维持或改善护理质量的知识鲜为人知。我们的经验发现将为ACO可以采用的费用时间表的修改设计。 PAMF正在研究如何将自己构建为ACO，因此其领导能力将评估我们的建议的可行性，并在广泛传播我们的建议之前对我们的建议进行了“现实测试”。