Impact of Health Deductible Health Plans on the Evaluation, Treatment, and Outcomes for Acute Coronary Syndrome

健康免赔额健康计划对急性冠脉综合征评估、治疗和结果的影响

基本信息

批准号：
10663659
负责人：
Shih-Chuan Chou
金额：
$ 16.99万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-09 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10663659
关键词：
Accident and Emergency department Active Learning Acute Acute myocardial infarction Adherence Admission activity Affect Award Behavior Cardiac Cardiovascular Diseases Cardiovascular system Caring Chest Pain Chronic Disease Clinical Complement Cost Sharing Cost-Sharing Insurance Data Databases Deductibles Disease Management Disease Outcome Elements Emergency Care Emergency Department evaluation Emergency Department patient Emergency Medicine Emergency Situation Emergency department visit Employee Enrollment Ensure Evaluation Face Financial Hardship Funding Future Goals Grant Growth Health Health Care Costs Health Insurance Healthcare Heart Diseases High Prevalence Hospitalization Image Incentives Inpatients Insurance Insurance Benefits Insurance Carriers Interview Ischemia Low Income Population Low income Measures Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Myocardial Infarction Natural experiment Observational Study Outcome Patient-Focused Outcomes Patients Perception Physicians Policies Price Qualitative Research Quality of Care Quasi-experiment Randomized Regulation Research Research Design Research Methodology Research Personnel Role Scientist Screening for cancer Severities Surveys Survival Analysis Testing Training Variant Visit Work Writing acute care acute coronary syndrome cardiovascular emergency care burden care outcomes care seeking career career development cost curriculum development design empowerment experience health care disparity health plan health savings account hospital readmission insight insurance claims interest member policy recommendation preservation research and development shared decision making

项目摘要

PROJECT ABSTRACT This K23 award will enable the candidate, Shih-Chuan Chou, MD, MPH, SM, to become an independent physician-scientist focused on the effect of out-of-pocket costs on care utilization and outcomes of acute chest pain and cardiovascular care. Chest pain is one of the most common reasons for emergency department (ED) evaluation, with over 7 million visits annually. ED visits ensure the timely identification and treatment of acute myocardial infarction (AMI) or acute coronary syndrome (ACS). However, the financial implications of care have escalated over the past two decades with the growth of high deductible health plans (HDHP). By 2020, nearly 6 in 10 US employees with employer-sponsored insurance will have deductibles of ≥$1,000. While research has begun to explore HDHP’s effect on cancer screening and chronic disease management, little research has examined how it affects acute cardiovascular care. In a preliminary study, Dr. Chou found that HDHP enrollment reduced ED visits for non-specific chest pain but increased AMI after chest pain admission among the lower-income population. In this K23, Dr. Chou will further extend this research with 3 proposed aims. Aim 1 will use segmented survival analysis in a large commercial claims database to examine whether employer-mandated HDHP enrollment negatively impacted AMI outcomes. Using the same database, aim 2 will utilize the natural randomization of patients to ED clinicians within each ED to determine whether HDHP reduces low-value chest pain admissions among clinicians with high admitting tendencies. Lastly, aim 3 will include patient surveys and interviews to elicit chest pain and AMI patients’ perspectives on how high out-of- pocket costs affected their decisions to seek care, perceived care quality, and subsequent financial impact. All aims will further focus on low-income patients that face disproportionate financial stress. Dr. Chou proposed a comprehensive career development curriculum to complement these aims, consisting of extensive didactic and experiential learning. Dr. Chou has assembled an interdisciplinary team of mentors with recognized expertise in quasi-experimental observational studies, insurance benefit design, cardiovascular emergencies, health care disparities, and emergency medicine, who will provide him with intensive mentorship in these topics. The proposed research and career development activities will allow Dr. Chou to establish his expertise in insurance-related policies, the financial burden of care, and their impact on the use and outcomes of patients with acute cardiovascular conditions. This award will enable Dr. Chou to transition into an independent clinician-scientist focusing on the short- and long-term impact of high out-of-pocket costs and the implications around the growing implementation of price transparency and cost discussions for acute unscheduled care visits. Completing the proposed research will generate robust evidence to advance the understanding of the clinical impact of patient financial burden, guide future regulations around insurance cost-sharing policies, and inform the implementation of price transparency initiatives in acute cardiovascular care.

项目摘要该K23奖将使候选人Shih-Chuan Chou，医学博士，MPH，SM成为独立身体科学家专注于自付成本对护理利用的影响和急性胸部的结果疼痛和心血管护理。胸痛是急诊科（ED）的最常见原因之一评估，每年有超过700万次访问。 ED访问确保及时识别和治疗急性心肌梗塞（AMI）或急性冠状动脉综合征（ACS）。但是，护理的财务影响在过去的二十年中，随着高扣除健康计划（HDHP）的增长，已经升级了。到2020年，拥有员工赞助保险的10个美国员工中有近6名将其免赔额≥1,000美元。尽管研究已经开始探索HDHP对癌症筛查和慢性疾病管理的影响，很少研究研究了它如何影响急性心血管护理。在一项初步研究中，周博士发现 HDHP入学率减少了非特异性胸痛的ED访问，但胸痛入院后AMI增加在低收入人群中。在此K23中，Chou博士将通过提议的3个进一步扩展这项研究目标。 AIM 1将在大型商业主张数据库中使用分段的生存分析来检查是否是否雇主授权的HDHP入学率对AMI结果产生了负面影响。使用相同的数据库，AIM 2 将利用患者在每个ED中的ED临床医生的自然随机化来确定是否HDHP 减少了高入院趋势的临床医生的低价值胸痛入院。最后，AIM 3将包括患者调查和访谈以引起胸痛，并就AMI患者的观点观点袋装成本影响了他们寻求护理，感知的护理质量以及随后的财务影响的决定。全部目标将进一步关注面临不成比例的财务压力的低收入患者。周博士提出了全面的职业发展课程以补充这些目标，包括广泛的教学和体验式学习。 Chou博士已经组建了一个具有公认专业知识的跨学科导师团队在准实验观察研究中，保险福利设计，心血管紧急情况，医疗保健差距和急诊医学，他们将在这些主题中为他提供密集的精神。拟议的研究和职业发展活动将使Chou博士能够建立他的专业知识与保险有关的保单，护理的经济燃烧及其对患者使用和结果的影响急性心血管疾病。该奖项将使Chou博士能够过渡到独立临床科学家专注于高自付成本的短期和长期影响及其影响围绕价格透明度的日益增长的实施和急性外护理的成本讨论访问。完成拟议的研究将产生强大的证据，以提高对患者财务燃烧的临床影响，指导围绕保险成本分担政策的未来法规，以及告知急性心血管护理中价格透明度计划的实施。