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之家 (PCMH) 是一种有前途的模式，用于转变初级保健的组织和提供，以实现高质量、可及性和高效的医疗保健。迄今为止，PCMH 评估的大部分内容都集中在大型集成交付系统中提高质量结果的成功上。迫切需要了解与支持、实施和维护为美国最弱势群体服务的中小型初级保健实践（即安全网）进行系统性重新设计相关的成本。卡特里娜飓风过后，大新奥尔良的安全网医疗保健系统开始在全系统范围内努力通过使用 PCMH 模式重建和改造初级保健，该模式得到了名为“初级保健获取和稳定补助金”的 1 亿美元联邦拨款的支持（PCASG）。初步结果表明，患者对 PCASG 诊所之间的护理协调的评价有所提高。我们的长期目标是提供全面的证据来支持美国初级保健实践变革的实施和可持续性，将 PCASG 计划作为 2007-2011 年的“自然实验”。目前缺乏数据来从个体诊所的角度估算PCMH转型的成本效应，以进一步改进高效、有效和可持续的PCMH模型。因此，本次成本评估的主要目的是量化新奥尔良中小型安全网实践成为 PCMH 所承担的直接和间接成本以及参与 PCMH 重新设计和实施活动的外部非财务成本。我们将使用 PCASG 计划数据，包括患者就诊情况、服务提供登记、运营预算和收入以及 PCMH 评分。我们将根据 PCASG 计划成本类别将总成本分为安全网实践的直接成本和间接成本（直接成本：临床和专科护理；间接成本：管理）。来自 PCMH 诊所和非 PCMH 诊所的成本衡量标准（例如，每个患者每月的成本和每个全职等效 (FTE) 医生的成本）将根据基线实践费用、PCMH 转型的增量成本和维持实践变化。外部非财务激励也将纳入成本评估。第二个目标是检查 PCASG 计划期间诊所层面的特征与初级保健实践的成本衡量指标之间的关联。利用PCASG数据源，我们将采用双重差分纵向模型来分析PCASG计划下成本措施的影响因素。该成本评估项目将为主要利益相关者（例如初级保健实践、医疗保健系统、医疗保健支付者和卫生政策制定者）​​提供有关变革性初级保健实践重新设计和实施的成本信息，并就初级保健的未来举措提出建议美国的变化。

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