Use and costs of low-value health services by Veterans in VA and non-VA settings

退伍军人事务部和非退伍军人事务部的退伍军人对低价值医疗服务的使用和费用

• 批准号: 10647622
• 负责人: Carolyn Timberlake Thorpe
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10647622
• 关键词: Address; Age; Area; Cardiovascular system; Caring; Categories; Classification; Communities; Community Healthcare; Data; Deimplementation; Diagnostic; Dimensions; Dual Enrollment; Eligibility Determination; Enrollment; Ensure; Evolution; Frequencies; Goals; Health Care Costs; Health Insurance; Health Personnel; Health Services; Health system; Healthcare; Healthcare Systems; Image; Intervention; Interview; Knowledge; Light; Longevity; Measures; Medical center; Medicare; Medicare claim; Methodology; Methods; Operative Surgical Procedures; Parents; Patients; Pattern; Performance; Policies; Population; Prevalence; Preventive; Privatization; Procedures; Provider; Quality of Care; Reporting; Research; Risk; Safety; Screening for cancer; Services; Statutes and Laws; Structure; Subgroup; Testing; United States; Variant; Veterans; Veterans Health Administration; Work; aged; beneficiary; cohort; cost; cost estimate; empowerment; health care settings; health economics; health service use; high risk; implementation efforts; improved; innovation; multidisciplinary; multilevel analysis; novel; operation; programs

Background: Overuse of health services whose immediate or downstream costs or harms exceed their benefits (i.e., low-value health services) is a major driver of healthcare costs in the United States. Comprehensive measures of low-value service use have been applied to identify low-value services with the highest utilization and costs in non-VA populations, but less is known about which low-value services are most frequently used and costly in Veterans managed in the Veterans Health Administration (VHA). Also, all Veterans aged 65+ are eligible to use non-VA care via Medicare, and Veterans of all ages increasingly receive care outside VA through VA Community Care (VACC). Past research suggests that dual use of VA and non- VA care places Veterans at risk for overuse of health services, but information on Veterans’ use of low-value services in non-VA settings is lacking. Significance/Impact: Our objective is to determine the extent of utilization, costs, and determinants of Veterans' low-value service use within and outside VA. Our study will identify the low-value services most commonly used by Veterans through VA Medical Centers (VAMCs), VACC, and dual Medicare benefits, and those that are most costly. This study will inform policies and interventions, including possible new quality metrics, to reduce low-value care provided to Veterans. Results will be valuable to our VA partners (Office of Reporting, Analysis, Performance Improvement and Deployment, and Office of Community Care) who are committed to ensuring that Veterans receive high-value services regardless of where they receive care. It will also empower Veterans to consider value of care when choosing between a VA vs non-VA setting. This study addresses two Veteran Care Priorities (health care value; quality/ safety of care) and the VA legislation priority to understand impact of non-VA care on value of care received by Veterans in light of the MISSION Act. Innovation: Current VA performance metrics capture key dimensions of access, quality, safety, and efficiency, but do not address Veterans' receipt of low-value care or quality of care received in non-VA settings. Our project will use novel methods to quantify use and determinants of an array of low-value services that Veterans may receive both within and outside of VA. Specific Aims: Aim 1: Quantify utilization and costs of low-value services provided to VHA enrollees in VAMCs and VACC, and characterize variation across VA facilities in low-value services provided in each setting. Aim 2: Quantify utilization and costs of low-value services used by dual VHA-Medicare enrollees in VAMCs and non-VA settings through Medicare, and characterize VA facility-level variation in low-value services provided in each setting. Aim 3: Identify barriers and facilitators of de-implementing low-value services in each setting. Methodology: In Aim 1, we will apply a claims-based measure of low-value care to VA utilization data and VACC data for a national cohort of VHA enrollees. We will identify frequency of use of 26 low-value services in 6 categories: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing/procedures, and surgery. We will apply average HERC cost estimates to calculate total costs of each service and category in VAMCs and in VACC. We will use multilevel modeling to examine facility variation in rates of VAMC and VACC low-value service use and extent to which Veteran and VAMC factors explain this variation. Aim 2 will involve similar analyses involving VA utilization data and Medicare claims for dual VA-Medicare enrollees. Aim 3 will apply latent profile analysis to facility-level estimates of low-value service categories to identify clusters of VAMCs with similar patterns of low-value service use in VA and non-VA settings. We will conduct interviews with VA providers who practice at VAMCs in different clusters to examine barriers and facilitators to de- implementing low-value services for Veterans. Next Steps & Implementation: We will use results to work with operations partners to develop performance measures, policies, and interventions to mitigate Veterans’ receipt of low-value care in VA and non-VA settings, as VA evolves as a provider and payer of Veteran care.

背景：过度使用其直接或下游成本或危害超过其的卫生服务 利益（即低价值医疗服务）是美国医疗保健费用的主要驱动力。 已经采用了低价值服务的综合措施来识别低价值服务 非VA人群的最高利用率和成本，但对哪种低价值服务最少了解 在退伍军人卫生管理局（VHA）中管理的退伍军人经常使用和昂贵。另外，全部 65岁以上的退伍军人有资格通过Medicare使用非VA护理，所有年龄段的退伍军人都越来越接受 通过VA社区护理（VACC）在VA外部护理。过去的研究表明，双重使用VA和非 - VA护理使退伍军人面临过度使用卫生服务的风险，但有关退伍军人使用低价值的信息 缺乏非VA设置中的服务。意义/影响：我们的目标是确定 VA内外退伍军人的低价值服务的利用，成本和确定。我们的研究愿意 确定退伍军人通过VA医疗中心（VAMC）最常用的低价值服务， VACC和双重医疗保险福利，以及最昂贵的疫苗。这项研究将为政策提供信息， 干预措施，包括可能的新质量指标，以减少向退伍军人提供的低价值护理。结果 对我们的VA合作伙伴（报告，分析，绩效改进和部署办公室， 和社区护理办公室）致力于确保退伍军人获得高价值服务 无论他们在哪里得到护理。它还将授权退伍军人在选择时考虑护理价值 在VA与非VA设置之间。这项研究针对两个资深护理优先事项（医疗保健价值；质量/ 护理安全）和VA立法的优先事项，以了解非VA护理对收到的护理价值的影响 根据《宣教法》，退伍军人。创新：当前的VA性能指标捕获了关键维度 访问，质量，安全性和效率，但不要解决退伍军人的低价值护理或护理质量 在非VA设置中收到。我们的项目将使用新颖的方法来量化使用并确定一系列 退伍军人可能会在VA内部和外部获得低价值服务。具体目的：目标1：量化 提供给VAMC和VAMC的VHA提供的低价值服务的利用率和成本，并表征 每种设置中提供的低价值服务中VA设施之间的变化。目标2：量化利用率和 双重VHA-Medicare使用的低价值服务的成本通过VAMC和非VA设置的成本 Medicare，以及在每种环境中提供的低价值服务中VA设施级别的变化。目标3： 在每种情况下确定脱离实力低价值服务的障碍和促进者。方法：在AIM 1中， 我们将对国家的VA利用率数据和vacc数据应用基于索赔的低价值护理措施 VHA的队列注册。我们将确定6类低价值服务的使用频率：癌症 筛查，诊断/预防性测试，术前测试，成像，心血管测试/程序以及 外科手术。我们将应用平均HERC成本估算来计算每种服务的总成本和类别 VAMC和疫苗中。我们将使用多级建模来检查VAMC和VACC速率的设施变化 低价值服务的使用以及退伍军人和VAMC因素在多大程度上解释了这种变化。 AIM 2将涉及 类似的分析涉及Dual VA-Medicare注册的VA利用数据和Medicare主张。目标3意志 将潜在概况分析应用于设施级别的低价值服务类别的估计，以识别 在VA和非VA设置中使用低价值服务的类似模式的VAMC。我们将进行采访 与VA的提供商在VAMC中的不同集群实践，以检查障碍和促进者 为退伍军人实施低价值服务。下一步和实施：我们将使用结果与 运营合作伙伴制定绩效指标，政策和干预措施，以减轻退伍军人的收据 随着VA的发展，VA和非VA设置中的低价值护理作为退伍军人护理的提供者和付款人的发展。