Estimating Costs of Supporting Safety-Net PCMH Transformation in New Orleans

估算支持新奥尔良安全网 PCMH 转型的成本

• 批准号: 8628492
• 负责人: LIZHENG SHI
• 金额: $ 10万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628492
• 关键词: Estimating; Costs; Supporting; Safety; Net

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) is one promising model for transforming the organization and delivery of primary care in order to achieve high-quality, accessible, and efficient health care. To date, much of the PCMH evaluation has focused on the success of improving quality outcomes in large integrated delivery systems. There is an urgent need to understand the costs associated with supporting, implementing, and maintaining systematic redesign of small and medium sized primary care practices that serve American's most vulnerable populations (i.e., the safety net). The safety net health care system in Greater New Orleans after Hurricane Katrina embarked on a system-wide effort to rebuild and transform primary care by using the PCMH model, which was supported by a $100-million federal grant called the Primary Care Access and Stabilization Grant (PCASG). The preliminary results have demonstrated an improved patient rating of care coordination among the PCASG clinics. Our long-term goal is to provide comprehensive evidence to support the implementation and sustainability of primary care practice change in the United States using the PCASG program as a "natural experiment" in years 2007-2011. There is a dearth of data to estimate the cost effects of PCMH transformation from the perspective of individual clinics to further improve efficient, effective, and sustainable PCMH models. Therefore, the primary aim of this cost evaluation will be to quantify the direct and indirect costs shouldered by New Orleans small and medium sized safety net practices in becoming PCMHs and external non-financial costs involved in PCMH redesign and implementation activities. We will use the PCASG program data including patient encounters, services delivery register, operating budget and revenues, and PCMH scores. We will separate total costs into direct and indirect costs of safety net practices according to the PCASG program cost categories (direct cost: clinical and specialty care; indirect cost: administrative). The cost measures (e.g., cost per patient per month and cost per full-time equivalent (FTE) physician) derived from PCMH clinics and non-PCMH clinics will be further summarized in terms of baseline practice expense, incremental cost of PCMH transformation, and maintenance of practice change. The external non-financial incentives will also be included in the cost evaluation. The secondary aim will be to examine the associations between clinic-level characteristics and cost measures in primary care practices over the period of the PCASG program. Using the PCASG data sources, we will employ difference-in-difference longitudinal models to analyze the influencing factors of the cost measures under the PCASG program. This cost evaluation project will provide key stakeholders (e.g., primary care practices, health care systems, health care payers, and health policy makers) with information about the costs of transformative primary care practice redesign and implementation and make recommendations on future initiatives for primary care change in the United States.

描述（由申请人提供）：以患者为中心的医疗住所（PCMH）是一种有前途的模型，用于改变组织和提供初级保健，以实现高质量，可访问和有效的医疗保健。迄今为止，许多PCMH评估都集中在改善大型集成输送系统中质量结果的成功。迫切需要了解与支持，实施和维护中小型初级保健实践的系统重新设计相关的成本，这些实践服务于美国最脆弱的人群（即安全网）。卡特里娜飓风之后，大新奥尔良的安全网卫生保健系统开始了全系统范围的努力，通过使用PCMH模型来重建和转变初级保健，该模型得到了1亿美元的联邦拨款，称为初级保健获得和稳定拨款（PCASG）。初步结果表明，PCASG诊所中患者的护理协调评级提高了。我们的长期目标是提供全面的证据，以支持美国在2007 - 2011年使用PCASG计划作为“自然实验”的美国初级保健实践改变的实施和可持续性。从单个诊所的角度来看，缺乏数据来估算PCMH转换的成本影响，以进一步提高高效，有效和可持续的PCMH模型。因此，该成本评估的主要目的是量化新奥尔良中小型安全网余下的直接和间接成本，以成为PCMHS和PCMH重新设计和实施活动涉及的外部非财务成本。我们将使用PCASG程序数据，包括患者遇到，服务输送注册，运营预算和收入以及PCMH分数。根据PCASG计划成本类别（直接成本：临床和专业护理；间接成本：行政管理），我们将将总成本分为直接和间接的安全网惯例成本。从PCMH诊所和非PCMH诊所得出的成本措施（例如，每位患者每位患者的费用和每位全职同等（FTE）医师的成本）将进一步总结，以基线实践费用，PCMH的增量成本，PCMH转换的增量成本以及实践更改的维持。外部非财务激励措施也将包括在成本评估中。次要目的是检查PCASG计划期间的临床水平特征与初级保健实践中的成本度量之间的关联。使用PCASG数据源，我们将采用差异差纵向模型来分析PCASG计划下的成本度量的影响因素。该成本评估项目将为关键的利益相关者（例如，初级保健实践，医疗保健系统，卫生保健付款人和健康政策制定者）​​提供有关转型性初级保健实践重新设计和实施成本的信息，并就美国初级保健变革的未来计划提出建议。

项目成果

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.

估算卡特里娜飓风过后新奥尔良支持安全网转变为以患者为中心的医疗之家的成本。

• DOI: 10.1097/md.0000000000004990
• 发表时间: 2016
• 期刊: Medicine
• 影响因子: 1.6
• 作者: Shao,Hui;Brown,Lisanne;Diana,MarkL;Schmidt,LauraA;Mason,Karen;Oronce,CarlosIrwin;Shi,Lizheng
• 通讯作者: Shi,Lizheng