Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

通过监测医疗补助质量、差异和价值来改善少数群体的健康

• 批准号: 9911999
• 负责人: Marcela V Horvitz-Lennon
• 金额: $ 73.2万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9911999
• 关键词: Adopted; Adult; Budgets; Caring; Chronic; County; Data; Data Sources; Databases; Development; Ethnic group; Fee-for-Service Plans; Foundations; Funding; Geography; Goals; Growth; Health Care Costs; Healthcare; Healthcare Fees; Individual; Latino; Lead; Link; Locales; Managed Care; Measurement; Measures; Medicaid; Medical; Mental Health; Mental disorders; Methodology; Minority; Monitor; Outcome; Patients; Pattern; Performance; Persons; Policies; Policy Making; Population; Premature Mortality; Psychometrics; Quality of Care; Reference Standards; Research; Research Personnel; Role; Schizophrenia; Services; State Government; Techniques; Time; Variant; Vulnerable Populations; Work; beneficiary; budget impact; care costs; comorbidity; cost; cost effectiveness; cost estimate; evidence base; health care disparity; health care quality; health care service; health disparity; improved; interactive tool; minority health; physical conditioning; programs; public health relevance; racial and ethnic; racial and ethnic disparities; response; routine care; severe mental illness; sociodemographic factors; success; tool; user-friendly

PROJECT SUMMARY Treating individuals with schizophrenia requires a broad array of services, including physical health care services, which are primarily financed by Medicaid. Despite high health care costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. Moreover, where patients live matters, with quality and quality disparities varying not just among states but also among counties within states. At a time of reform and fiscal constraint, Medicaid programs are challenged with improving quality and reducing quality disparities among high-needs beneficiaries, including those with schizophrenia, at no extra costs. Factors likely to impact a program’s success include its ability to 1) comprehensively measure quality of care, capturing key domains of both mental health and physical health care, 2) validly and feasibly measure the value of care routinely delivered to their beneficiaries, and importantly, 3) incorporate racial/ethnic disparities in the assessment of value. Such measurement efforts should be undertaken at the level of meaningful geographic units such as counties, where patterns of health care are influenced by policies reflecting both state and local priorities. In response to FOA 16-221, we propose a program of research that seeks to reduce health disparities and improve the health of minority populations served in publicly funded settings through measurement of quality disparities and other critical domains of Medicaid-financed care delivered to adults with schizophrenia living in five diverse states. We will measure quality using evidence- based indicators, and exploiting psychometric principles, we will create an overall composite score as well as key sub-scores. Using the composite measure, we will assess racial/ethnic and geographic disparities in overall quality of care; value, defined as the cost to the Medicaid state program of producing high-quality care; and the cost to the program of eliminating racial/ethnic disparities in quality. We will integrate quality and costs through a unique cost-effectiveness methodology, and to our knowledge, our work will be the first to quantitatively link disparities and costs of serious mental illness care. Our ultimate goal is to provide policymakers with a user-friendly interactive tool to monitor quality, quality disparities, costs, and value, thus enabling evidence-based policymaking. Aim 1 will assess racial/ethnic and geographic disparities in quality of mental health, physical health, and overall health care routinely delivered to beneficiaries with schizophrenia. Aim 2 will develop and implement a cost-effectiveness framework to assess value, operationalized as the incremental net monetary benefit of care. Aim 3 will use the statewide white population as a reference standard to determine the cost of eliminating racial/ethnic quality disparities in each county. Aim 4 will develop and pilot a user-friendly interactive tool to enable state Medicaid programs to monitor quality, disparities, costs, and value of care. We expect that the proposed research will contribute to the eradication of disparities through advanced performance measurement techniques that will enable routine monitoring of Medicaid care.

项目概要 治疗精神分裂症患者需要广泛的服务，包括身体保健 这些服务主要由医疗补助计划资助，尽管医疗保健费用很高，但大多数患者并不这样做。 接受推荐的护理，而且少数族裔比白人更不可能这样做。此外，在患者居住的地方。 问题在于，质量和质量差异不仅在各州之间存在差异，而且在各县之间也存在差异。 在改革和财政紧缩的时期，医疗补助计划面临着提高质量和质量的挑战。 减少高需求受益人（包括精神分裂症患者）之间的质量差距，无需额外费用 可能影响项目成功的因素包括其以下能力：1) 全面衡量项目质量。 护理，抓住心理健康和身体健康护理的关键领域，2) 有效且可行的测量 定期向受益人提供护理的价值，重要的是，3) 纳入种族/民族 这种衡量工作应该在价值评估的层面上进行。 有意义的地理单位，例如县，其医疗保健模式受到政策的影响 为了响应 FOA 16-221，我们提出了一项研究计划，以反映州和地方的优先事项。 力求减少健康差距并改善公共资助的少数族裔人口的健康 通过衡量质量差异和医疗补助资助的护理的其他关键领域来调整环境 我们将使用证据来衡量质量。 基于指标并利用心理测量原理，我们将创建一个总体综合分数以及 使用综合衡量标准，我们将评估种族/民族和地理差异。 护理的总体质量；价值，定义为提供高质量护理的医疗补助州计划的成本； 以及消除种族/民族质量差异计划的成本 我们将整合质量和成本。 通过独特的成本效益方法，据我们所知，我们的工作将是第一个 我们的最终目标是提供严重精神疾病护理的差异和费用。 决策者可以使用用户友好的交互式工具来监控质量、质量差异、成本和价值，从而 目标 1 将评估种族/民族和地理质量差异。 定期向精神分裂症受益人提供心理健康、身体健康和整体医疗保健。 目标 2 将制定并实施一个成本效益框架来评估价值，并作为 目标 3 将以圈养白人人口作为参考增量净货币效益。 将制定确定消除每个县种族/民族素质差异的成本的标准。 并试点用户友好的互动工具，使州医疗补助计划能够监控质量、差异、成本、 我们期望拟议的研究将有助于消除差异。 先进的绩效测量技术将使医疗补助护理的日常监测成为可能。