The Impact of Health Care Reform on Addiction and HIV Services

医疗保健改革对成瘾和艾滋病毒服务的影响

基本信息

批准号：
8836997
负责人：
CYNTHIA I CAMPBELL
金额：
$ 44.03万
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：
2013
资助国家：
美国
起止时间：
2013-05-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8836997
关键词：
Affect Benchmarking CD4 Lymphocyte Count California Caring Characteristics Clinic Clinical Comorbidity Computerized Medical Record Cost Sharing Data Deductibles Demographic Accounting Diagnosis Diagnostic Services Elements Enrollment Future HIV HIV Seropositivity Health Health Care Costs Health Care Reform Health Insurance Health Planning Health Policy Health Services Health Services Accessibility Healthcare Healthcare Systems Individual Inpatients Interview Measures Mediating Medicaid Medical Methods Organizational Change Organizational Models Outcome Patients Pattern Phase Registries Route Sampling Services Silver Socioeconomic Status Statutes and Laws Substance Use Disorder System Time Treatment Cost Viral Vulnerable Populations Work addiction base cohort cost demographics design health care delivery health care service utilization implementation research improved innovation member patient population response screening service utilization theories

项目摘要

Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plans extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.

医疗保健改革立法对获得服务和扩大医疗服务范围具有重大影响为那些患有物质使用障碍 (SUD) 的人，特别是艾滋病毒感染者带来好处。这些条件是与多种医疗和精神合并症以及高昂的医疗费用有关。回应 RFA-DA-13-001，拟议的研究重点关注《平价医疗法案》(ACA) 的关键要素，该法案将该计划于 2014 年实施，可能会增加对 SUD 和艾滋病毒治疗服务的需求。该研究评估在非常适合 ACA 实施研究的护理环境中，ACA 对患有 SUD 的个人的影响。北加州凯撒医疗机构 (KPNC) 是一个大型医疗保健系统，提供综合 SUD 和医疗，并已被指定为加州小团体计划的全州基准健康保险交换。我们的创新方法是基于一个综合概念模型组织理论和卫生服务利用。在这项分阶段研究中，R21 阶段的目标是分析会员人口统计和临床复杂性、服务使用和成本，使用一组新加入的 ACA 前健康计划成员 (n=3641) 并拥有 SUD，包括成员同时患有 SUD 和 HIV。在 R33 阶段，我们使用前后设计将 R21 队列与第二个队列进行比较，使用高级双重差分法对新注册的具有 SUD 的 KPNC 成员进行 ACA 队列研究分析 2014 年开始的 ACA 相关变化的方法。主要成果包括成员变化、卫生服务的利用和成本、SUD 治疗的启动和保留以及艾滋病毒管理。后- ACA 队列也将在两年内进行纵向跟踪。通过创新的混合方法，我们使用来自健康计划广泛的电子病历的数据，并辅以定性访谈与组织和临床领导者就 ACA 相关的福利计划、服务交付、劳动力以及影响 ACA 实施的障碍或促进因素。调查结果将提供大量信息了解健康计划如何实施 ACA 并为新投保的 SUD 和 HIV 患者提供服务人口，并将为未来的卫生政策做出贡献。