Identifying effective strategies used by Medicare Accountable Care Organizations to improve outcomes for patients with heart failure: A mixed-methods study

确定 Medicare 责任医疗组织用于改善心力衰竭患者预后的有效策略：一项混合方法研究

• 批准号: 10327259
• 负责人: Tara C Lagu
• 金额: $ 61.55万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327259
• 关键词: Acute; Admission activity; Adult; American; Care given by nurses; Caring; Case Manager; Cessation of life; Characteristics; Clinical Protocols; Clinical Research; Data; Disease; Diuretics; Enrollment; Ensure; Feedback; Future; Goals; Health; Health Personnel; Health Policy; Health system; Healthcare; Heart failure; Heterogeneity; Hospitalization; Hospitals; Incentives; Individual; Intervention; Interview; Investigation; Knowledge; Lead; Measurement; Medicare; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; PF4 Gene; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Phenotype; Population; Predictive Analytics; Prevalence; Primary Health Care; Process; Provider; Quality of Care; Records; Research; Risk; Sampling; Savings; Services; Skilled Nursing Facilities; Standardization; Statistical Data Interpretation; Surveys; System; Testing; Time; Translational Research; Variant; Work; base; beneficiary; burden of illness; care costs; care delivery; care outcomes; contextual factors; cost; disability; experience; high risk; hospital admission rate; implementation research; improved; improved outcome; informant; insight; medical specialties; mortality; novel; population health; prevent; primary outcome; programs; secondary outcome; time use; trend

PROJECT SUMMARY More than 5.7 million American adults experience heart failure (HF), and prevalence is expected to increase by 46% in the next two decades. Total costs of HF care exceed $30 billion annually. Patients with HF are at high risk for poor outcomes, including hospitalization, disability, and death. A novel intervention for lowering costs and improving quality of care for Medicare beneficiaries is the implementation of Accountable Care Organizations (ACOs). ACOs consist of groups of doctors and other health care entities that come together voluntarily to provide their patients with coordinated, high-quality care. If this results in lower costs, the ACO shares the savings with the Medicare program. ACOs are simultaneously required to meet quality metrics to ensure that cost reductions are the result of improvements in population health (and not the result of denying services to beneficiaries). As of 2017, the Medicare Shared Savings Program (MSSP), a large Medicare program that provides incentives for ACO formation, included more than 9 million Medicare patients across more than 400 ACOs nationwide. Preliminary data suggests there is variation across ACOs in outcomes for patients with HF. We hypothesize that this variation is related to differences in the organization and delivery of care within ACOs. For example, use or implementation of care management may vary across ACOs, leading to differences in outcomes. Our long-term goal is to identify effective delivery-system interventions that improve the health and outcomes of patients with HF. The objective of this proposal is to identify the strategies and contextual factors that lead some ACOs to achieve better risk-standardized outcomes including: lower acute admission rates (RSAARs), fewer days in skilled nursing care (RSSNFs), and lower mortality rates (RSMRs). Aim 1 will examine outcomes across ACOs and identify patterns in the trajectories of outcomes over time. Each ACO will be assigned a “phenotype” based on trends in risk-standardized outcomes. We will then examine the association between phenotypes with ACO characteristics. In Aim 2, we will conduct qualitative interviews with a sample of ACOs taken from high- and low- performing phenotypes with the goal of refining our understanding of the factors and strategies that allow some ACOs to achieve better outcomes. For Aim 3, we will conduct a survey of all remaining MSSP ACOs (those not sampled in Aim 2) to examine associations between identified strategies and outcomes using multinomial regression. The results of this work will inform health system leaders and policymakers as they implement care management strategies within ACOs and consider changes to the MSSP more broadly. These activities are highly responsive to the National Heart Lung and Blood Institute’s Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational, clinical, and implementation research to improve health and reduce disease.”

项目摘要 超过570万美国成年人患有心力衰竭（HF），预计患病率将增加 在接下来的二十年中，增长了46％。 HF护理的总成本每年超过300亿美元。 HF患者处于 不良预后的高风险，包括住院，残疾和死亡。降低新颖的干预措施 成本和提高医疗保险受益人的护理质量是实施责任心 组织（ACO）。 ACO由聚集在一起的医生和其他医疗保健实体组成 自愿为患者提供协调的高质量护理。如果这导致成本较低，则ACO 与Medicare计划分享储蓄。仅要求ACO满足优质指标 确保降低成本是人口健康改善的结果（而不是拒绝的结果 受益人的服务）。截至2017年，Medicare共享储蓄计划（MSSP），这是一个大型Medicare 提供激励ACO组的计划，包括超过900万Medicare患者 全国有400多个ACO。初步数据表明，ACO之间的结果有所不同 HF患者。我们假设这种差异与组织的差异和交付有关 ACO内的护理。例如，使用或实施护理管理可能会有所不同，导致 结果的差异。 我们的长期目标是确定有效的交付系统干预措施，以改善健康状况和 HF患者的结局。该提案的目的是确定策略和上下文因素 这导致一些ACO获得更好的风险标准化结果，包括：较低的急性入院率 （RSAAR），熟练护理护理（RSSNF）的日子较少，死亡率较低（RSMR）。目标1意志 检查跨ACO的结果，并识别随着时间的推移结果轨迹的模式。每个ACO都会 根据风险标准的结果的趋势分配“表型”。然后，我们将检查 与ACO特征的表型之间的关联。在AIM 2中，我们将与 从高性和低性能表型中取出的ACO样本，目的是完善我们的理解 在允许某些ACO取得更好结果的因素和策略中。对于AIM 3，我们将进行 调查所有其余的MSSP ACO（未在AIM 2中采样的ACO），以检查已识别的关联 使用多项式回归的策略和结果。这项工作的结果将为卫生系统提供信息 领导者和政策制定者在ACO内实施护理管理策略并考虑更改 到MSSP更广泛。这些活动对民族心脏肺和血液的反应很高 研究所的战略目标，特别是目标6，旨在“优化翻译， 临床和实施研究，以改善健康和减少疾病。”

项目成果

Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement.

• DOI: 10.1161/jaha.122.029758
• 发表时间: 2023-07-04
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Chuzi, Sarah;Lindenauer, Peter K.;Faridi, Kamal;Priya, Aruna;Pekow, Penelope S.;D'Aunno, Thomas;Mazor, Kathleen M.;Stefan, Mihaela S.;Spatz, Erica S.;Gilstrap, Lauren;Werner, Rachel M.;Lagu, Tara
• 通讯作者: Lagu, Tara

US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability.

• DOI: 10.1377/hlthaff.2021.01136
• 发表时间: 2022-01
• 期刊: Health affairs (Project Hope)
• 作者: Iezzoni LI;Rao SR;Ressalam J;Bolcic-Jankovic D;Agaronnik ND;Lagu T;Pendo E;Campbell EG
• 通讯作者: Campbell EG

The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study.

董事会组成与医疗保险共享储蓄计划责任护理组织成果之间的关系：一项观察性研究。

• DOI: 10.1007/s11606-021-07053-4
• 发表时间: 2022
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Reimold,KimberlyE;Faridi,MohammadKamal;Pekow,PenelopeS;Erban,Joshua;Flannelly,Colin;Luikart,Ysabella;Lindenauer,PeterK;DeJong,Christene;D'Aunno,Tom;Lagu,Tara
• 通讯作者: Lagu,Tara

Examining the "Repletion Reflex": The Association between Serum Potassium and Outcomes in Hospitalized Patients with Heart Failure.

检查“补充反射”：血清钾与心力衰竭住院患者的预后之间的关联。

• DOI: 10.12788/jhm.3270
• 发表时间: 2019
• 期刊: Journal of hospital medicine
• 影响因子: 2.6
• 作者: O'Sullivan,KevinF;Kashef,MohammadAmin;Knee,AlexanderB;Roseman,AlexanderS;Pekow,PenelopeS;Stefan,MihaelaS;Shieh,Meng-Shiou;Pack,QuinnR;Lindenauer,PeterK;Lagu,Tara
• 通讯作者: Lagu,Tara

Physician Beliefs About Online Reporting of Quality and Experience Data.

医生对在线质量和经验数据报告的看法。

• DOI: 10.1007/s11606-019-05267-1
• 发表时间: 2019
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Lagu,Tara;Haskell,Jacqueline;Cooper,Emily;Harris,DanielA;Murray,Anne;Gardner,RebekahL
• 通讯作者: Gardner,RebekahL