The Impact of Health Homes in New York State on People with Substance Use Disorde

纽约州健康之家对药物滥用患者的影响

• 批准号: 8823037
• 负责人: JON MORGENSTERN
• 金额: $ 58.44万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8823037
• 关键词: AIDS/HIV problem; Accident and Emergency department; Accounting; Adult; Aftercare; Agreement; Alcohol or Other Drugs use; Amendment; Behavioral; Bipolar I; Budgets; Caring; Case Manager; Chronic; Chronically Ill; Client; Clinical; Cost Control; Data; Data Analyses; Data Set; Development; Drug Metabolic Detoxication; Enrollment; Ensure; Feedback; Fostering; Funding; Glycosylated hemoglobin A; HIV Seropositivity; Health; Health Care Costs; Health Care Reform; Healthcare; Home environment; Homelessness; Hospitals; Individual; Inpatients; Logistic Regressions; Measures; Mediator of activation protein; Medicaid; Medical; Mental Health; Mental disorders; Metric; Modeling; Mood stabilizers; New York; Outcome; Outcome Measure; Patient-Centered Care; Patients; Performance; Phase; Population; Primary Health Care; Provider; Quality Indicator; Quality of Care; Records; Registries; Regression Analysis; Rehabilitation therapy; Research; Research Infrastructure; Scoring Method; Series; Subgroup; Substance Use Disorder; Testing; Time; Viral Load result; Visit; Vulnerable Populations; Writing; addiction; administrative database; base; chronic care model; comparison group; cost; diabetic; health care service utilization; health information technology; high risk; improved; longitudinal design; pressure; programs; severe mental illness; stem

The expansion of healthcare coverage through Medicaid will allow greater access to SUD treatment among those who currently do not have coverage. However, States will be concerned about cost containment as expansion of coverage will increase pressures on strained budgets. Health Homes (HHs) are a federally funded Medicaid programauthorized by the Affordable Care Actto improve quality of care and reduce wasteful spending for chronic medical and behavioral conditions. HHs aim to increase patient centered care among the most vulnerable populations covered under Medicaid. New York (NY) has received federal approval and is currently rolling out its HH program statewide (anticipated enrollment of about 750,000). The NY HHs program has distinct features including a focus on SUD among enrollees with chronic medical and mental health disorders, fostering of local partnerships among diverse types of providers, and use of care managers to ensure patient centered care. Using a longitudinal design, this study will examine whether the NY HH program improves quality of care, reduces inefficient healthcare, and lowers costs among the 120,000/year individuals with SUD who are eligible for HHs in NY. Administrative data from 2006 through 2016 will be derived from a combination of Medicaid claims and encounters and SUD state registry records which include sociodemographics and substance use data. The study will occur in two phases. In the R21 Phase (1 Year), Primary Aims focus on putting a research infrastructure in place by establishing written agreements with state agencies, creating analytical datasets, and developing a statistical description of initial HH enrollees. Data analysis will include using descriptive and mixed effects logistic regression analyses to describe and contrast historical and baseline socio-demographic, clinical and healthcare utilization among subgroups (e.g., HH eligible with no SUD; high risk clients with SUD). In the R33 Phase (4 years), Primary Aims include examining whether HHs improve Medicaid quality indicators of SUD treatment, quality of medical and mental health care among SUD clients, efficiency of healthcare (e.g., avoidable rehospitalizations), as well as reduce Medicaid costs. Mixed effects logistic regression models will examine changes from historical rates of quality of care metrics and of costs while controlling for a variety of factors (e.g., individual clinically complicating factors). Generalized gamma models will be used to examine Medicaid costs by year. Secondary Aims focus on providing further evidence for making causal inferences about the effect of HHs on outcomes. Regression analyses will explore the relationship between HH program and quality and costs by comparing enrollees to statistically matched non-enrollees, examining the association between care manager activity and outcomes, and the association between moderators (e.g., homelessness) and mediators (e.g., primary care engagement) with efficiency and costs. Findings will have relevance as other states expand Medicaid coverage and use similar reform efforts for chronic conditions targeting the costliest and neediest populations.

通过医疗补助的扩大医疗保险将允许更多地使用SUD治疗 那些目前没有承保范围的人。但是，各州将担心成本控制 覆盖范围的扩大将增加预算紧张的压力。卫生之家（HHS）是联邦政府 由《平价医疗法案》授权的资助医疗补助计划，以提高护理质量并减少 长期医疗和行为状况的浪费支出。 HHS旨在增加以患者为中心的护理 在医疗补助涵盖的最脆弱的人群中。纽约（纽约）已获得联邦批准 目前正在全州范围内推出其HH计划（预计约750,000名）。纽约HHS 计划具有不同的功能，包括关注慢性医疗和精神的参与者中的SUD 健康障碍，各种类型提供者之间的当地合作伙伴关系以及使用护理经理来 确保以患者为中心的护理。使用纵向设计，本研究将检查纽约HH计划是否 提高护理质量，降低效率低下的医疗保健以及降低120,000/年个人的成本 与符合纽约HHS的SUD。从2006年到2016年的行政数据将来自 医疗补助索赔和遭遇以及SUD州注册表记录的结合，包括社会人口统计学 和物质使用数据。该研究将分为两个阶段。在R21阶段（1年）中 旨在通过与国家建立书面协议来建立研究基础设施 代理商，创建分析数据集并开发对初始HH参与者的统计描述。数据 分析将包括使用描述性和混合效应逻辑回归分析来描述和对比 历史和基线社会人口统计学，临床和医疗保健利用率（例如，HH） 符合条件没有SUD；具有SUD的高风险客户）。在R33阶段（4年），主要目的包括检查 HHS是否改善医疗补助质量指标，医疗和精神保健质量 在SUD客户中 费用。混合效果逻辑回归模型将检查护理质量质量的变化 指标和成本在控制各种因素（例如个体临床上复杂因素）的同时。 通用的伽马模型将用于一年一度检查医疗补助成本。次要目标关注 提供进一步的证据，以对HHS对结果的影响进行因果推断。回归 分析将通过比较注册者与 统计上匹配的非能勒，检查了护理经理活动与成果之间的关联， 以及主持人（例如无家可归者）和调解人（例如初级保健参与）之间的关联 效率和成本。随着其他州扩大医疗补助覆盖范围并使用，调查结果将具有相关性 针对最昂贵，最需要的人口的慢性病的类似改革努力。