New York State Health Home Impact on HIV Treatment Cascade

纽约州健康之家对艾滋病毒治疗级联的影响

基本信息

批准号：
9094485
负责人：
JON MORGENSTERN
金额：
$ 64.72万
依托单位：
PARTNERSHIP TO END ADDICTION
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：
2014-07-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9094485
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Affordable Care Act Anti-Retroviral Agents Behavioral Bipolar Disorder Caring Case Manager Characteristics Chronic Disease Client Clinical Continuity of Patient Care Contracts Country Data Data Set Drug Metabolic Detoxication Effectiveness Enrollment Glycosylated hemoglobin A HIV HIV Seropositivity Health Health Care Costs Health Care Reform Health Personnel Healthcare Healthcare Systems High Prevalence Home environment Homeless persons Homelessness Housing Human immunodeficiency virus test Indigent Individual Infection Inpatients Intervention Studies Knowledge Life Low income Measures Medicaid Medical Mental Health Mental disorders Methods Mood stabilizers Nature New York Outcome Paint Participant Patient-Focused Outcomes Persons Policies Population Provider Public Health Public Sector Qualitative Research Quality of Care Quality of life Regimen Reporting Research Research Methodology Risk Series Services Social Work Substance Use Disorder System Technology Testing Time United States Viral Viral Load result antiretroviral therapy behavioral health care systems compliance behavior cost diabetic evidence base health care availability housing instability improved longitudinal design medication compliance novel strategies programs social stem supported housing surveillance data transmission process

项目摘要

DESCRIPTION (provided by applicant): In order to slow the spread of HIV and improve health outcomes for persons living with HIV/AIDS (PLWHA), the Affordable Care Act greatly expands access to health care for low-income PLWHA. Further, the Office of National AIDS Policy has created a strategy to improve the current system of care by closing gaps in the HIV care continuum. The HIV care continuum outlines a series of steps in addressing infection: a) HIV testing, b) engagement in HIV care, c) participation in antiretroviral therapy (ART), and d) the ultimate target-viral suppression. Surveillance data paint a dismal picture of the continuum of care in the United States, with less than 25% of PLWHA having undetectable viral load. Given the fragmented, crisis-driven nature of the current health care system, individuals who are homeless or unstably housed may continue to receive low quality care or no care at all. The high prevalence of substance use disorders, mental illness, and other chronic illnesses among unstably housed, HIV-positive individuals increases the difficulty in engaging this group in care. The Affordable Care Act includes a number of important healthcare system restructuring provisions for chronic illness management, among which are Health Homes (HH) for Medicaid recipients. New York (NY) Department of Health (DOH) has created one of the country's earliest and most ambitious implementations of HHs. NY HH's are newly formed integrated healthcare networks of medical and behavioral health providers that contract to provide integrated care through shared care managers and common technology platforms. Additionally, NY DOH has a pilot program to provide 544 units of supportive housing (SH) for homeless PLWHA enrolled in HHs. This study will test 1) whether SH combined with HHs improves quality of care for 544 homeless PLWHA HH enrollees and 2) whether New York HH improve quality of care and costs to 8,250 Medicaid homeless PLWHA enrolled in HHs. The primary aims will be addressed in two ways. First, we will compare HIV continuum and other quality metrics and Medicaid costs between homeless PLWHA in SH and those who did not receive supportive housing using nonparametric difference-in-difference methods. Second, we will implement a longitudinal design using administrative data from 2009 through 2016 to examine changes in quality of care and Medicaid costs for homeless PLWHA in Medicaid. The project comes from an academic- public sector partnership to address high priority questions of healthcare system redesign. Data will come from surveillance data on all HIV lab tests conducted in NY, Medicaid encounters/claims, and from HHs reporting on client functioning and care manager contacts. These data will be merged to create DE identified analytical datasets by DOH. Additional qualitative research methods will be employed to elucidate the HH factors associated with outcomes. If aims are achieved, the study is likely to have a major impact on improving knowledge about evidence-based approaches to address homeless PLWHA. In addition, because the study intervention is part of ACA, the policy impact of the study findings on national healthcare may be substantial.

描述（由申请人提供）：为了减缓艾滋病毒的传播并改善艾滋病毒感染者/艾滋病患者 (PLWHA) 的健康状况，《平价医疗法案》极大地扩大了低收入艾滋病毒感染者/艾滋病患者获得医疗保健的机会。此外，国家艾滋病政策办公室制定了一项战略，通过缩小艾滋病毒护理连续性中的差距来改善当前的护理系统。 HIV 护理连续体概述了解决感染问题的一系列步骤：a) HIV 检测，b) 参与 HIV 护理，c) 参与抗逆转录病毒治疗 (ART)，以及 d) 最终目标病毒抑制。监测数据描绘了美国护理连续性的惨淡景象，不到 25% 的感染者病毒载量无法检测到。鉴于当前医疗保健系统分散、危机驱动的性质，无家可归或住房不稳定的个人可能会继续接受低质量的护理或根本得不到护理。在居住不稳定的艾滋病毒阳性者中，药物滥用障碍、精神疾病和其他慢性疾病的患病率很高，这增加了让这一群体接受护理的难度。《平价医疗法案》包括许多针对慢性病管理的重要医疗保健系统重组条款，其中包括为医疗补助受益人提供的健康之家 (HH)。纽约 (NY) 卫生部 (DOH) 制定了美国最早、最雄心勃勃的 HH 实施方案之一。 NY HH 是新成立的由医疗和行为健康提供者组成的综合医疗保健网络，他们通过共享护理管理器和通用技术平台签订合同提供综合护理。此外，纽约州卫生部还制定了一项试点计划，为 HH 中登记的无家可归的 PLWHA 提供 544 套支持性住房 (SH)。本研究将测试 1) SH 与 HH 相结合是否可以提高 544 名无家可归的 PLWHA HH 登记者的护理质量，以及 2) 纽约 HH 是否可以提高在 HH 登记的 8,250 名医疗补助无家可归的 PLWHA 的护理质量和费用。主要目标将通过两种方式实现。首先，我们将使用非参数双重差分法比较上海无家可归者和未获得支持性住房的艾滋病毒连续体和其他质量指标以及医疗补助成本。其次，我们将使用 2009 年至 2016 年的行政数据实施纵向设计，以检查医疗补助中无家可归的感染者的护理质量和医疗补助成本的变化。该项目来自学术界与公共部门的合作，旨在解决医疗保健系统重新设计的高度优先问题。数据将来自纽约州进行的所有 HIV 实验室检测、医疗补助遭遇/索赔的监测数据，以及来自 HH 的客户功能和护理经理联系人报告。这些数据将被合并以创建由 DOH 确定的 DE 分析数据集。将采用其他定性研究方法来阐明与结果相关的 HH 因素。如果目标实现，这项研究可能会对提高人们对解决无家可归者感染者的循证方法的认识产生重大影响。此外，由于研究干预是 ACA 的一部分，因此研究结果对国家医疗保健的政策影响可能很大。