Measuring the Value of Improving Access to Community Care

衡量改善社区护理服务的价值

• 批准号: 10847381
• 负责人: Edwin S. Wong
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10847381
• 关键词: Address; Appointment; Area; Budgets; Businesses; Cardiology; Caring; Characteristics; Communities; Community Care Networks; Community Healthcare; Community Networks; Contracts; Data; Data Linkages; Degree program; Development; Dimensions; Econometric Models; Eligibility Determination; Ensure; Evaluation; Facilities and Administrative Costs; Future; Geographic Locations; Goals; Health Policy; Health Services Accessibility; Health care facility; Healthcare; Healthcare Systems; Heterogeneity; Improve Access; Individual; Learning; Light; Literature; Location; Logit Models; Marketing; Measurement; Measures; Medical; Methodology; Methods; Modeling; Observational Study; Office Management; Outpatients; Parameter Estimation; Patient Preferences; Patient Selection; Patients; Perception; Performance; Policies; Policy Maker; Primary Care; Provider; Quality of Care; Recommendation; Relaxation; Role; Science; Specific qualifier value; Statutes and Laws; Strategic Planning; Time; Travel; United States; Validation; Veterans; Wait Time; care systems; cost; design; econometrics; economic value; health assessment; health care availability; health care quality; health care service; health economics; improved; innovation; interest; medical specialties; novel; opportunity cost; outpatient programs; preference; programs; simulation; stem; tool; willingness to pay

Background: Providing timely access to health care has been a long-standing VA goal that has been re- emphasized by the Commission on Care. To improve access to care, VA implemented the Veterans Choice Program in August 2014, which provides eligible Veterans the option of receiving care from community providers paid for by VA. Currently, there is a substantial gap in scientific evidence on the effect of the Choice Program and other VA community care programs, particularly in regards to the degree the program has improved access to care. More generally, non-VA literature examining the effect of greater provider options has focused on changes in utilization, but has not assessed the value of improved patient choice. The development of measures that capture the value of greater provider options is methodologically challenging because patients’ preferences are not directly observed and value encompasses many dimensions of access (e.g., travel distance, appointment wait times, provider quality, etc.). To address these evidence gaps, we propose the development and examination of new measures capturing the value of provider options to Veterans using state-of-the art econometric methods. Greater scientific evidence to help VA provide enhanced choice for Veterans through the Choice Program and future VA community care programs is consistent with the VHA FY 2018-2019 Operational Plan. This study addresses the ORD-wide Learning Health Care System priority area and HSR&D’s Access and Health Care Systems Change major priority domains. Objectives: The objectives of this study are to: 1) develop new econometric method applications to quantitatively measure the value of greater access to providers from the perspective of Veterans and 2) examine the relative importance of local area and provider characteristics in determining Veterans’ value of having improved access to providers. Methods: This observational study will examine VA administrative data and existing public data characterizing outpatient providers. In Aim 1, we will use VA administrative data to identify: 1) Veterans eligible for the VA Choice Program in 2016, 2) VA and Choice outpatient providers and 3) utilization of outpatient services from VA facilities and through the Choice Program. We will analyze Veterans’ revealed preference for providers using econometric random utility models. These models assume patients select the provider that yields the greatest benefit, given all available options. We will empirically estimate Veterans’ choice of provider within the random utility framework using a nested multinomial logit model (NMNL). We will then use parameter estimates and predictive margins from the NMNL model to calculate the value of greater provider options through the Choice Program. Specifically, econometric models will calculate Veterans’ willingness to pay (WTP), which represents the maximum dollar amount an individual would theoretically pay for greater provider options. In Aim 2, we will apply econometric decomposition methods to models developed in Aim 1 to assess the influence of key provider and local area characteristics in determining value. Notably, we will leverage novel data linkages between VA administrative data and public use data capturing an extensive set of provider characteristics. Statement on Next Steps: We will develop a simulation tool designed for non-researchers that incorporates study results to estimate the value to Veterans of a specified set of provider options (i.e. a community care network). This tool will provide the ability for operational partners to assess the adequacy of community care networks and establish the business case of “what-if” scenarios. Stakeholders will be able to adapt to changing conditions through simulating the hypothetical addition and subtraction of providers within a community care network. This simulation feature will facilitate future analyses to ensure community care networks include high quality providers that best match Veterans’ preferences.

背景：提供及时获得医疗保健一直是一个长期存在的VA目标 由护理委员会强调。为了改善获得护理的机会，VA实施了退伍军人选择 2014年8月的计划，为符合条件的退伍军人提供从社区接受护理的选择 提供者由VA支付。目前，科学证据在选择的影响方面存在很大的差距 计划和其他VA社区护理计划，特别是在该计划的程度方面 改善了获得护理的机会。更一般地，非VA文献研究了更大的提供商选择的效果 专注于利用的变化，但尚未评估改善患者选择的价值。这 制定捕获更大提供商选择价值的措施在方法论上挑战 因为未直接观察到患者的偏好，并且价值包括许多访问的维度 （例如，旅行距离，约会等待时间，提供商质量等）。为了解决这些证据差距，我们 提议制定和审查新措施，以捕获提供者选择价值 退伍军人使用最先进的经济方法。帮助VA提供的更多科学证据提供了增强 通过选择计划和未来的VA社区护理计划为退伍军人选择与 VHA FY 2018-2019运营计划。这项研究涉及范围内的学习医疗保健系统 优先区域和HSR＆D的访问和卫生保健系统会改变主要的优先领域。 目的：本研究的目标是：1）开发新的经济方法应用 从数量上衡量从退伍军人的角度衡量更大访问提供者的价值，而2） 检查本地和提供商特征在确定退伍军人的价值方面的相对重要性 改善了访问提供商的机会。 方法：这项观察性研究将检查VA管理数据和现有的公共数据表征 门诊提供商。在AIM 1中，我们将使用VA管理数据来识别：1）符合VA的退伍军人 2016年的选择计划，2）VA和选择门诊提供商，3）利用门诊服务 VA设施和通过选择计划。我们将分析退伍军人对提供者的偏爱 使用经济随机效用模型。这些模型假设患者选择了产生的提供者 鉴于所有可用的选项，最大的好处。我们将在经验上估计退伍军人选择提供商 使用嵌套多项式logit模型（NMNL）的随机实用程序框架。然后，我们将使用参数 NMNL模型的估计和预测利润率，以计算更大的提供商选项的价值 通过选择程序。具体而言，经济模型将计算退伍军人付款的意愿 （WTP），代表个人理论上将支付更大提供商的最高金额 选项。在AIM 2中，我们将将经济分解方法应用于AIM 1中开发的模型以评估 主要提供商和局部特征在确定价值方面的影响。值得注意的是，我们将利用 VA管理数据与公共用途数据之间的新颖数据链接捕获了一系列提供商 特征。 下一步的声明：我们将开发一个仿真工具，专为合并的非研究人员设计 研究结果以估计对一套指定提供者选项的退伍军人的价值（即社区护理 网络）。该工具将为运营合作伙伴评估社区护理的充分性提供能力 网络并建立“假设”方案的业务案例。利益相关者将能够适应变化 通过模拟社区护理中提供商的假设加法和减法的条件 网络。此仿真功能将促进将来的分析，以确保社区护理网络包括高 优质的提供商，最适合退伍军人的喜好。

项目成果

How Did Veterans' Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?

• DOI: 10.1097/mlr.0000000000001764
• 发表时间: 2022-10-01
• 期刊: MEDICAL CARE
• 影响因子: 3
• 作者: Sterling, Ryan A.;Liu, Chuan-Fen;Wong, Edwin S.
• 通讯作者: Wong, Edwin S.