Value-based Purchasing in Implementation of Depression Care in Community Clinics

基于价值的采购在社区诊所抑郁症护理实施中的应用

基本信息

批准号：
8748476
负责人：
Yuhua Bao
金额：
$ 44.16万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8748476
关键词：
Accident and Emergency department Accounting Adopted Adoption American Area Behavioral Beryllium Caring Chronic Care Chronic Disease Clinic Communities Community Health Contracts County Data Databases Effectiveness Elements Enrollment Environment Funding Future Goals Health Care Costs Health Insurance Healthcare Hospitalization Incentives Knowledge Learning Link Low income Measures Mediating Mediator of activation protein Medicare Mental Depression Mental Health Modeling Natural experiment Outcome Patients Performance Phase Policies Population Primary Health Care Process Provider Registries Resources Role Source Specific qualifier value Time Uninsured Update Washington base behavioral health burden of illness collaborative care cost depressive symptoms design evidence base health care service utilization health organization improved meetings patient population payment population health programs psychosocial public health relevance response tool

项目摘要

ABSTRACT As many as 40 million low-income Americans will rely on community health clinics (CHCs) for primary care by 2019. Depression and other behavioral health conditions are a major source of disease burden in this population. Implementation of evidence-based behavioral health care is a priority area for CHCs. The goal of this study is to assess the role of Value-Based Purchasing (VBP), a policy strategy, to enhance planned implementation of evidence-based care in CHCs. VBP is a tool to spur quality improvement by linking payment to provider organizations with pre-specified performance targets. The proposed study will leverage a unique VBP program initiated by the Washington State Mental Health Integration Program (MHIP). MHIP implements the CollaborativeCare model, a prominent, evidence-based model to integrate behavioral health care into primary care. MHIP's multi-phase VBP embeds several desirable design features and offers a rare opportunity to produce generalizable findings on the effectiveness of VBP to support implementation of evidence-based chronic care. We will conduct retrospective analysis of existing data based on MHIP registry and health care claims of over 12,000 patients from 52 CHCs in Washington State's King and Pierce Counties. Aims of the study are to assess the effects of MHIP VBP on: 1. Adoption of CollaborativeCare by CHCs; and, 2. Patient outcomes. We will measure adoption based on CHC performance of key process-of-care elements of CollaborativeCare at the patient-episode level. Patient outcomes include depression symptoms, hospitalization, emergency room use and total health care costs. Our analytical strategy will exploit the natural experiment created by the rolling enrollment of patients into MHIP. Specifically, we will compare outcomes pertaining to patient-episodes that occurred pre-, peri-, and post- VBP while controlling for the continuous learning and adopting processes at CHCs. Preliminary data suggest overall low adoption pre-VBP, substantial improvement over time, and CHC behavioral responses to VBP incentives that are consistent with the conceptual framework of the proposed study. This study will generate critical knowledge to assist policymakers with their decisions on whether to use VBP to enhance implementation of evidence-based care in CHCs and how to best design VBP to maximize its impact.

抽象的多达 4000 万低收入美国人将依靠社区卫生诊所 (CHC) 获得初级保健 2019.抑郁症和其他行为健康状况是该地区疾病负担的主要来源人口。实施循证行为卫生保健是社区卫生中心的优先领域。目标是本研究旨在评估基于价值的采购（VBP）这一政策策略在增强计划采购方面的作用。在社区卫生中心实施循证护理。 VBP是一个通过链接支付来刺激质量改进的工具向具有预先指定绩效目标的提供商组织提供。拟议的研究将利用独特的 VBP 计划由华盛顿州心理健康整合计划 (MHIP) 发起。 MHIP实施 CollaborativeCare 模型，一种突出的、基于证据的模型，将行为保健纳入初级保健。 MHIP 的多相 VBP 嵌入了多种理想的设计功能，并提供了难得的机会就 VBP 的有效性得出普遍结论，以支持实施基于证据的慢性护理。我们将根据 MHIP 登记和医疗保健对现有数据进行回顾性分析来自华盛顿州金县和皮尔斯县 52 个 CHC 的 12,000 多名患者的索赔。的目标研究旨在评估 MHIP VBP 对以下方面的影响： 1. CHC 采用协作护理；以及， 2. 病人结果。我们将根据 CHC 关键护理流程要素的表现来衡量采用情况患者级别的协作护理。患者的结果包括抑郁症状、住院、急诊室使用和总医疗保健费用。我们的分析策略将利用自然通过将患者滚动登记到 MHIP 中而创建的实验。具体来说，我们将比较结果与发生在 VBP 之前、期间和之后的患者发作有关，同时控制连续性 CHC 的学习和采用流程。初步数据表明 VBP 之前整体采用率较低，但随着时间的推移而改善，CHC 对 VBP 激励措施的行为反应与拟议研究的概念框架。这项研究将产生关键知识来帮助政策制定者决定是否使用 VBP 来加强社区卫生中心循证护理的实施，以及如何最好地设计 VBP 以最大化其影响。