Implementing Health Plan-Level Care Management for Solo & Small Practices

为 Solo 实施健康计划级护理管理

• 批准号: 8719899
• 负责人: AMY M KILBOURNE
• 金额: $ 18.72万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-13 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8719899
• 关键词: Implementing; Health; Plan; Level; Care

DESCRIPTION (provided by applicant): The 2011 HHS report on multiple chronic conditions highlighted the prevalence, morbidity, and cost associated with clusters of co-occurring chronic conditions, both physical and mental. Collaborative chronic care models (CCMs) are effective in treating chronic medical and mental illnesses at little to no net healthcare cost. To date CCMs have primarily been implemented at the facility level and adopted by larger, public healthcare organizations. However, the vast majority of primary care and behavioral health practices providing commercially insured care are far too small to implement such models. Health plan-level CCMs can address this unmet need. Based on a groundbreaking partnership with Aetna Inc., the goal of this study is to implement a cross-diagnosis CCM designed to improve outcomes for persons with mood disorders with an eye towards developing a business case for a generalizable plan-level CCM for solo or small practices. Mood disorders (depression and bipolar disorder) were identified by Aetna as priority conditions because of their chronic nature and high healthcare costs. While evidence-based care parameters have been well established, quality of medical and psychiatric care and health outcomes are suboptimal for persons with mood disorders. We will conduct a randomized controlled trial of the cross-diagnosis CCM vs. education control among Aetna beneficiaries across the country who were hospitalized for unipolar depression or bipolar disorder and treated in solo or small primary care or behavioral health practices. At hospitalization discharge a total of 172 solo or small practices involving a total of 344 patients will be randomized to one year of outpatient treatment augmented by the CCM or education control. CCM components include care management that will be fully remote from practice venues and patients, implemented by the Aetna care management center in Salt Lake City, provider guideline support, and web-based self-management support (Life Goals program). The primary health outcomes are mood disorder symptoms, health-related quality of life, hospitalizations, and guideline- based mood disorders and cardiometabolic management. Secondary outcomes include determining the provider and organizational factors associated with CCM outcomes and uptake including health IT capacity, cost effectiveness of the CCM compared to education control, and development of a business plan based on empirical data and stakeholder input. This proposed R18 addresses AHRQ's research demonstration and dissemination priorities, particularly around prevention and care management. In addition to this groundbreaking practice-research partnership focused on solo or small practices to further implement CCMs at the health plan level, this study may also lead to the evolution of the business case for cross-diagnosis CCMs in general, and the utility of plan-level panel management and remote e-health technologies, especially with the advent of accountable care organizations and similar initiatives.

描述（由申请人提供）：2011 年 HHS 关于多种慢性病的报告强调了与同时发生的身体和精神慢性病集群相关的患病率、发病率和成本。协作慢性护理模式 (CCM) 可有效治疗慢性医疗和精神疾病，且净医疗成本很少甚至为零。迄今为止，CCM 主要在设施层面实施，并被大型公共医疗机构采用。然而，绝大多数提供商业保险护理的初级保健和行为健康实践规模太小，无法实施此类模式。卫生计划级别的 CCM 可以解决这一未满足的需求。基于与 Aetna Inc. 的突破性合作，本研究的目标是实施交叉诊断 CCM，旨在改善情绪障碍患者的治疗结果，着眼于为单独或个人的通用计划级 CCM 开发商业案例。小做法。情绪障碍（抑郁症和双相情感障碍）因其慢性性质和高昂的医疗费用而被 Aetna 确定为优先病症。虽然基于证据的护理参数已经得到很好的确立，但对于情绪障碍患者来说，医疗和精神科护理的质量以及健康结果并不理想。我们将对全国范围内因单相抑郁症或双相情感障碍住院并接受单独或小型初级保健或行为健康实践治疗的 Aetna 受益人进行交叉诊断 CCM 与教育控制的随机对照试验。出院时，共有 172 家个体诊所或小型诊所（总共涉及 344 名患者）将被随机分配接受为期一年的门诊治疗，并辅以 CCM 或教育控制。 CCM 组成部分包括由盐湖城 Aetna 护理管理中心实施的完全远离实践场所和患者的护理管理、提供者指南支持和基于网络的自我管理支持（生命目标计划）。主要健康结局是情绪障碍症状、与健康相关的生活质量、住院治疗以及基于指南的情绪障碍和心脏代谢管理。次要结果包括确定与 CCM 结果和采用相关的提供者和组织因素，包括卫生 IT 能力、CCM 与教育控制相比的成本效益，以及基于经验数据和利益相关者输入制定业务计划。拟议的 R18 涉及 AHRQ 的研究示范和传播优先事项，特别是围绕预防和护理管理。除了这种专注于单独或小型实践以在健康计划层面进一步实施 CCM 的突破性实践研究伙伴关系之外，这项研究还可能导致交叉诊断 CCM 商业案例的发展，以及计划的实用性级专家组管理和远程电子医疗技术，特别是随着责任护理组织和类似举措的出现。