Examining the Costs of a Medical Home Transformation for Seniors

检查老年人医疗之家改造的成本

• 批准号: 8628685
• 负责人: Arturo Vargas Bustamante
• 金额: $ 10万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628685
• 关键词: Examining; Costs; Medical; Home; Transformation

Quantifying Costs of a Medical Home Transformation for Seniors ABSTRACT: The proposed project aims to generate evidence about the costs of implementing Patient Centered Medical Home (PCMH) components by comparing costs of a wellness care redesign for older adult patients of HealthCare Partners Medical Group (HCP), an integrated medical group with 31 practice sites, and 213 practices sites of HCP's network of Independent Practice Associations (IPAs), totaling 244 primary care practice sites in the greater Los Angeles area. Previous research has underscored that patients of integrated medical groups receive higher quality of care and report better experiences of care compared to patients of IPA physicians (1, 2). No research, has examined the resource requirements and costs for managing the preventive care of clinically complex older adult patients across these organizational models. Transforming small primary care practices into PCMHs has been very difficult for clinicians and staff of small practices because of the limited quality improvement (QI) infrastructure and practice redesign experiences available in IPA settings (3). Consequently, start-up and incremental expenses are likely to be higher in IPA practices with extensive coordination costs due to providing more services off-site. We hypothesize that the start-up costs and incremental expenses associated with senior wellness care redesign will be lower, on average, for primary care practice sites in the integrated medical group compared to the IPA primary care practice sites. HCP is an Accountable Care Organization (ACO) at the forefront of testing innovations for delivering chronic illness care to diverse patient populations. To further examine "real world" cost impacts of PCMH implementation, UCLA, HCP Medical Group, and the HCP Institute for Applied Research and Education propose to partner to: 1. Develop a cost capture template (CCT) for the senior wellness care redesign using the "Prescription for Health" (P4H) framework of cost estimation, 2. Retrospectively quantify start-up, incremental and staff practice expenses corresponding to the senior wellness care redesign in HCP's integrated primary care practices (PCPs), 3. Compare the start-up, incremental and staff expenses for site- level implementation of the PCMH redesign between HCP's and IPAs' PCPs and perform sensitivity analyses. PCMHs aim to foster long-term relationships between patients and healthcare providers to more effectively manage ongoing health conditions and improving treatment adherence. The relative costs of fostering patient- centered wellness care for older adult patients, however, have not been explored. To our knowledge, no study has simultaneously estimated start-up and incremental practice expenses for PCMH transformation and compared these costs in primary care practices of integrated medical groups and IPAs. The proposed comparative cost analyses will be completed in 18 months. The results will benefit policy leaders and public and private healthcare organizations when resourcing implementation of PCMH components and incentivizing practice changes to improve care for older adults with multiple chronic conditions in diverse PCP settings.

量化老年人医疗家庭转型的费用 抽象的： 拟议的项目旨在为实施以患者为中心的医疗的成本生成证据 家庭（PCMH）组件通过比较对老年人的健康护理的成本进行比较 Healthcare Partners Medical Group（HCP），一个拥有31个练习场的综合医学集团，213 HCP独立实践协会网络（IPA）的实践站点，总计244个初级保健 大洛杉矶地区的练习地点。先前的研究强调了综合患者 与患者相比 IPA医生（1，2）。没有研究，已经检查了管理资源要求和成本 在这些组织模型中对临床复杂的老年人患者的预防性护理。转型 对于临床医生和小型实践的临床医生和工作人员来说，小型初级保健实践非常困难 由于质量有限（QI）基础架构和实践重新设计经验有限 IPA设置（3）。因此，在IPA实践中，启动和增量费用可能会更高 由于提供更多服务的服务而导致的广泛协调费用。我们假设启动成本 与高级健康护理重新设计相关的增量支出平均将较低 与IPA初级保健实践相比 站点。 HCP是一个负责任的护理组织（ACO），位于测试创新的最前沿 慢性病护理给多样化的患者人群。进一步检查PCMH的“现实世界”成本影响 实施，加州大学洛杉矶分校，HCP医学集团和HCP应用研究与教育研究所 建议合作：1。为高级健康护理重新设计使用成本捕获模板（CCT） 成本估算的“健康处方”（P4H）框架，2。回顾性量化启动， 与HCP的高级健康护理重新设计相对应的增量和员工实践费用 综合初级保健实践（PCP），3。比较现场的启动，增量和员工费用 - HCP和IPA的PCP之间的PCMH重新设计的级别实现并执行灵敏度分析。 PCMHS旨在促进患者与医疗保健提供者之间的长期关系，以更有效地 管理正在进行的健康状况并改善治疗依从性。培养患者的相对成本 - 但是，尚未探讨针对老年患者的中心健康护理。据我们所知，没有学习 同时估计了PCMH转换的启动和增量实践费用 比较了综合医疗团体和IPA的初级保健实践中的这些费用。提议 比较成本分析将在18个月内完成。结果将使政策领导人和公众受益 以及PCMH组件的实施并激励私人医疗组织 练习更改以改善各种PCP环境中多种慢性病的老年人的护理。