Insurance Coverage and Workforce Incentives to Improve Access to Surgical Care

保险覆盖范围和劳动力激励措施以改善获得外科护理的机会

基本信息

批准号：
10733703
负责人：
Andrew Mounir Ibrahim
金额：
$ 43.45万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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：
2023-07-01 至 2027-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10733703
关键词：
Abdominal Aortic Aneurysm Adopted Adverse event Advocate Age Distribution American Area Caring Colonic Diseases Colorectal Cancer Communities Complication Congresses Country County Crowding Data Disease Progression Eligibility Determination Emergency Situation Evaluation Exposure to Geography Health Care Costs Health Insurance Health Occupations Health Services Accessibility Health system Healthcare Hernia of abdominal cavity Improve Access Incentives Income Distributions Individual Inpatients Insurance Insurance Coverage Intervention Life Measures Medicaid Medicare Medicare claim Methods Modification Natural experiment Obstruction Operative Surgical Procedures Outcome Outpatients Patients Policies Policy Maker Policy Making Politics Primary Care Procedures Provider Quasi-experiment Research Design Resources Rupture Schedule Surgeon Symptoms Techniques Testing Tracer Uninsured United States United States Centers for Medicare and Medicaid Services Variant Ventral Hernia beneficiary cost demographics density evidence base experience health professional shortage areas high risk hospital readmission improved incentive program mortality operation prevent primary care provider response simulation

项目摘要

PROJECT SUMMARY ABSTRACT Improving access to surgical care remains a persistent challenge in the United States. While some areas of the country are crowded with high-intensity resources, more than a third of US counties do not have a single surgeon. Even in areas where there are enough providers, more than 29 million American lack insurance coverage preventing access to elective surgical care. As a result of a limited surgical workforce, inadequate insurance coverage or both, patients with limited access delay care until the condition requires emergent intervention. These emergency operations, that are more costly than their elective counterparts due to more complication and readmissions, are estimated to account for more than $1 billion in preventable spending. In response, the Centers for Medicare and Medicaid Services (CMS) implemented multiple access strategies including broader insurance coverage (e.g. Medicaid Expansion) and workforce incentives (e.g. Health Profession Shortage Areas (HPSA)). By improving access, the policies are meant to facilitate elective surgical care, prevent adverse events and reduce episode spending. Because the CMS policies outlined here focus on improving access, we will evaluate a broad range access sensitive surgical conditions. These conditions are preferentially treated with elective, or scheduled, operations when access is optimal. However, when access is limited, their natural progression leads to unresolving symptoms that ultimately require an emergency surgical procedure. Examples include abdominal aortic aneurysms which can rupture, ventral hernias which can strangulate, and colorectal cancers that can cause life-threatening obstructions. As such, these operations being performed electively versus emergently can serve as an indicator of access. Each CMS policy was implemented with both geographic and temporal variation resulting in beneficiaries exposed to one policy, both policies or neither. We will exploit these overlapping natural experiments to understand and isolate the effects of each policy alone as well as their combined effects using administrative claims from Medicare Claims and Healthcare Costs Utilization Project. We will leverage our extensive experience with natural experiment study design to appropriately isolate the effects of each policy on surgical access, quality and costs. This study will bring important evidence to evidence-based policy making as many states are still adopting Medicaid Expansion and congress debates the merits of continued HPSA subsidies.

项目摘要摘要在美国，改善手术护理的进入仍然是一项持续的挑战。而有些该国地区拥有高强度的资源，超过三分之一的美国县没有单身外科医生。即使在有足够的提供商的地区，也有超过2900万的美国人保险范围，阻止获得选修手术护理。由于有限的手术劳动力，保险范围不足或两者兼而有之，有限的访问延迟护理患者直到病情需要紧急干预。这些紧急行动比其选修课更为昂贵对于更多的并发症和再入院，估计可预防的10亿美元以上开支。作为回应，医疗保险和医疗补助服务中心（CMS）实施了多个访问包括更广泛的保险范围（例如医疗补助扩张）和劳动力激励措施（例如，卫生专业短缺地区（HPSA））。通过改善访问，政策旨在促进选修课手术护理，防止不良事件并减少发作支出。因为这里概述了CMS政策专注于改善访问，我们将评估广泛的访问敏感手术条件。这些当访问最佳时，条件优先处理选修或计划的操作。然而，当访问受限时，它们的自然发展会导致无法解决的症状，最终需要紧急手术程序。例子包括可能破裂的腹主动脉瘤，腹侧可以扼杀的疝气，以及可能导致威胁生命的障碍物的结直肠癌。像这样，这些操作被选举与紧急进行，可以作为访问的指标。每个CMS 政策是通过地理和时间变化实施的，导致受益者暴露于一个政策，无论是政策还是都不是。我们将利用这些重叠的自然实验来理解和隔离仅使用Medicare的行政主张，仅每个政策的影响以及它们的综合效果索赔和医疗保健成本利用项目。我们将利用自然的丰富经验实验研究设计，以适当隔离每个政策对手术访问，质量和质量的影响费用。这项研究将为基于循证的政策制定带来重要的证据，因为许多州仍在采用医疗补助扩张和国会辩论持续HPSA补贴的优点。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Understanding the impacts of rural hospital closures: A scoping review.

了解农村医院关闭的影响：范围界定审查。

DOI：
10.1111/jrh.12801
发表时间：
2024
期刊：
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
影响因子：
0
作者：
Mullens,CodyLendon;Hernandez,JAndres;Murthy,Jeevan;Hendren,Steph;Zahnd,WhitneyE;Ibrahim,AndrewM;Scott,JohnW
通讯作者：
Scott,JohnW

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative.

改善急诊普通外科手术的结果：构建协作质量计划。

DOI：
10.1097/ta.0000000000004248
发表时间：
2024
期刊：
The journal of trauma and acute care surgery
影响因子：
0
作者：
Hemmila,MarkR;Neiman,PoojaU;Hoppe,BeckieL;Gerhardinger,Laura;Kramer,KimA;Jakubus,JillL;Mikhail,JudyN;Yang,AmandaY;Lindsey,HughJ;Golden,RoyJ;Mitchell,EricJ;Scott,JohnW;Napolitano,LenaM
通讯作者：
Napolitano,LenaM

Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015-19.

初级保健短缺地区急诊手术、严重并发症和再入院率较高，2015-19 年。