Exploring Medicare Provider Networks: Implications for Adoption of CER Findings

探索医疗保险提供者网络：采用 CER 研究结果的影响

• 批准号: 8332819
• 负责人: Jay Bhattacharya
• 金额: $ 19.75万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8332819
• 关键词: Adopted; Adoption; Affect; Area; Cardiac; Caring; Characteristics; Chronic; Chronic Care; Clinical; Coronary; Data; Diabetes Mellitus; Evidence based practice; Expenditure; Future; Geographic Locations; Geography; Goals; Growth; Health; Health Expenditures; Healthcare; Long-Term Care; Medical; Medicare; Medicare claim; Minority; Myocardial Ischemia; Outcome; Outcomes Research; Patients; Patterns of Care; Physicians; Policies; Population; Procedures; Provider; Publications; Publishing; Research; Savings; Seminal; Social Network; Specialist; Stents; Structure; Surgeon; Testing; Time; Variant; Woman; Work; abstracting; base; clinical practice; cohort; comparative effectiveness; cost; cost effective; design; effectiveness research; evidence base; improved; payment; response; virtual

Abstract If comparative effectiveness research (CER) is to reduce health expenditure growth without compromising health outcomes, providers will need to adopt long-term cost-saving strategies that are identified as being no less effective than higher-cost clinical strategies. Understanding how provider "virtual" networks for Medicare influence the cost and content of care may be important when considering health reforms designed to promote the use of lower-cost effective medical care. We propose identifying factors that determine or influence the use of cost-saving yet effective clinical strategies. We further propose investigating the influence of Medicare provider networks (virtual or social networks) and their structure on the cost and content (e.g., evidence-based practices or not) of care provided. Our specific aims are to: 1) determine the extent to which supply and demand factors predict provider adoption of cost-saving evidence-based findings, 2) analyze provider network structure for differences in and influence on the use of evidence-based practices and costs of care, 3) estimate potential Medicare expenditure savings based on policies implementing these findings (perhaps through the use of payment or health reforms such as bundled payments or ACOs). We will base our analysis on the complete Medicare claims files for Parts A and B from years 2005 to 2010 and Part D from 2006 to 2010. Specifically, we will apply these aims to the treatment of patients with chronic stable angina and the use of revascularization with coronary stents before and after evidence-based findings (the COURAGE trial in 2007) were published supporting the initial use of medical management. We will identify the relevant cohort from the Medicare claims files for the time period before and after the time of publication, and identify factors that predicted a change in provider practices from revascularization with stents to medical management in the data. We will control for demographic and patient-level characteristics, investigate ecological and supply determinants, and investigate differences across geographies and patient sub-populations such as women, minorities, and those with diabetes. Next, we will identify provider networks of care for chronic stable angina in the Medicare data, and explore whether provider network structure influences the cost or content of care provided (concordant with evidence-based practices or not). We will explore whether network structures differ across geographies, and whether this partially explains the difference in practice variation and cost between regions. We will identify ways that our findings might be integrated into health reform policies either to optimize the factors we identify as determinants of low-cost yet effective care or to encourage efficient provider network formation. Finally, we will estimate potential Medicare savings based upon these policies.

抽象的 如果比较有效性研究（CER）是为了减少健康支出的增长而不损害 健康成果，提供者将需要采用长期省成本的策略，这些策略被确定为没有 不如更高成本的临床策略有效。了解医疗保险的提供商如何“虚拟”网络 在考虑旨在促进的健康改革时，影响护理的成本和内容可能很重要 使用低成本的有效医疗服务。 我们建议识别确定或影响使用省略成本但有效临床使用的因素 策略。我们进一步建议调查Medicare提供商网络（虚拟或社会网络的影响） 网络）及其在提供的护理成本和内容（例如，是否基于证据的实践）上的结构。 我们的具体目的是：1）确定供求因素预测提供者采用的程度 基于循证的循证发现，2）分析提供商网络结构的差异和影响 关于使用循证实践和护理成本，3）估计潜在的Medicare支出节省 根据实施这些发现的政策（也许是通过使用付款或健康改革，例如 捆绑付款或ACO）。 我们将根据2005年至2010年的A和B部分的完整Medicare索赔文件进行分析 并从2006年到2010年的D部分。具体来说，我们将将这些目标应用于慢性患者的治疗 稳定的心绞痛以及在基于证据的发现之前和之后使用冠状动脉支架的血运重建 （2007年的勇气审判）发表了支持医疗管理的初始使用。我们将 从Medicare索赔文件中确定相关队列的文件 出版，并确定预测提供者实践变化的因素，从具有支架的血运重建 到数据中的医疗管理。我们将控制人口统计和患者级特征， 调查生态和供应决定因素，并调查地理和患者之间的差异 妇女，少数民族和糖尿病患者等子人群。接下来，我们将确定提供商网络 医疗保险数据中慢性稳定心绞痛的护理，并探索提供商网络结构是否 影响提供的护理成本或内容（是否与循证实践一致）。我们将 探索网络结构在各个地理上是否有所不同，以及这是否部分解释了差异 实际上，区域之间的变化和成本。我们将确定我们的发现可能被整合到 卫生改革政策要么优化我们确定为低成本但有效护理的决定因素的因素，要么 鼓励有效的提供商网络形成。最后，我们将估计基于医疗保险的潜在储蓄 根据这些政策。