Identifying effective strategies used by Medicare Accountable Care Organizations to improve outcomes for patients with heart failure: A mixed-methods study

确定 Medicare 责任医疗组织用于改善心力衰竭患者预后的有效策略：一项混合方法研究

• 批准号: 9926915
• 负责人: Tara C Lagu
• 金额: $ 69.72万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2020-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926915
• 关键词: Acute; Admission activity; Adult; American; Care given by nurses; Caring; Case Manager; Cessation of life; Characteristics; Clinical Protocols; Clinical Research; Data; Disease; Diuretics; Enrollment; Ensure; Feedback; Future; Goals; Health; Health Personnel; Health Policy; Health system; Healthcare; Heart failure; Heterogeneity; Hospitalization; Hospitals; Incentives; Individual; Intervention; Interview; Investigation; Knowledge; Lead; Measurement; Medicare; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; PF4 Gene; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Phenotype; Population; Predictive Analytics; Prevalence; Primary Health Care; Process; Provider; Quality of Care; Records; Research; Risk; Sampling; Savings; Services; Skilled Nursing Facilities; Standardization; Statistical Data Interpretation; Surveys; System; Testing; Time; Translational Research; Variant; Work; base; beneficiary; burden of illness; care costs; care delivery; care outcomes; contextual factors; cost; disability; experience; high risk; hospital admission rate; implementation research; implementation strategy; improved; improved outcome; informant; insight; medical specialties; mortality; novel; population health; prevent; primary outcome; programs; secondary outcome; time use; trend

PROJECT SUMMARY More than 5.7 million American adults experience heart failure (HF), and prevalence is expected to increase by 46% in the next two decades. Total costs of HF care exceed $30 billion annually. Patients with HF are at high risk for poor outcomes, including hospitalization, disability, and death. A novel intervention for lowering costs and improving quality of care for Medicare beneficiaries is the implementation of Accountable Care Organizations (ACOs). ACOs consist of groups of doctors and other health care entities that come together voluntarily to provide their patients with coordinated, high-quality care. If this results in lower costs, the ACO shares the savings with the Medicare program. ACOs are simultaneously required to meet quality metrics to ensure that cost reductions are the result of improvements in population health (and not the result of denying services to beneficiaries). As of 2017, the Medicare Shared Savings Program (MSSP), a large Medicare program that provides incentives for ACO formation, included more than 9 million Medicare patients across more than 400 ACOs nationwide. Preliminary data suggests there is variation across ACOs in outcomes for patients with HF. We hypothesize that this variation is related to differences in the organization and delivery of care within ACOs. For example, use or implementation of care management may vary across ACOs, leading to differences in outcomes. Our long-term goal is to identify effective delivery-system interventions that improve the health and outcomes of patients with HF. The objective of this proposal is to identify the strategies and contextual factors that lead some ACOs to achieve better risk-standardized outcomes including: lower acute admission rates (RSAARs), fewer days in skilled nursing care (RSSNFs), and lower mortality rates (RSMRs). Aim 1 will examine outcomes across ACOs and identify patterns in the trajectories of outcomes over time. Each ACO will be assigned a “phenotype” based on trends in risk-standardized outcomes. We will then examine the association between phenotypes with ACO characteristics. In Aim 2, we will conduct qualitative interviews with a sample of ACOs taken from high- and low- performing phenotypes with the goal of refining our understanding of the factors and strategies that allow some ACOs to achieve better outcomes. For Aim 3, we will conduct a survey of all remaining MSSP ACOs (those not sampled in Aim 2) to examine associations between identified strategies and outcomes using multinomial regression. The results of this work will inform health system leaders and policymakers as they implement care management strategies within ACOs and consider changes to the MSSP more broadly. These activities are highly responsive to the National Heart Lung and Blood Institute’s Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational, clinical, and implementation research to improve health and reduce disease.”

项目概要 超过 570 万美国成年人患有心力衰竭 (HF)，患病率预计还会增加 未来 20 年，心力衰竭患者的护理总费用将超过 300 亿美元。 不良结果的高风险，包括住院、残疾和死亡。 成本和提高医疗保险受益人的护理质量是实施责任护理 组织 (ACO) 由医生和其他医疗保健实体组成。 自愿为患者提供协调的、高质量的护理如果这可以降低成本，ACO。 与 Medicare 计划分享节省的费用同时需要满足质量指标 确保成本降低是人口健康改善的结果（而不是否认 截至 2017 年，医疗保险共享储蓄计划 (MSSP) 是一项大型医疗保险。 为 ACO 形成提供激励的计划，涵盖了超过 900 万医疗保险患者 全国 400 多个 ACO 的初步数据表明，不同 ACO 的结果存在差异。 我们勇敢地承认，这种差异与心力衰竭患者的组织和输送方式的差异有关。 例如，ACO 内护理管理的使用或实施可能会有所不同，从而导致 结果的差异。 我们的长期目标是确定有效的交付系统干预措施，以改善健康和 该提案的目的是确定策略和背景因素。 导致一些 ACO 实现更好的风险标准化结果，包括： 降低急性入院率 (RSAAR)、更少的熟练护理天数 (RSSNF) 和更低的死亡率 (RSMR) 目标 1 将实现。 检查 ACO 的结果并确定每个 ACO 随时间推移的结果轨迹模式。 然后，我们将根据风险标准化结果的趋势来分配“表型”。 表型与 ACO 特征之间的关联 在目标 2 中，我们将进行定性访谈。 从高绩效和低绩效表型中提取的 ACO 样本，目的是加深我们的理解 对于使一些 ACO 取得更好成果的因素和策略，我们将进行一次调查。 对所有剩余的 MSSP ACO（目标 2 中未抽样的）进行调查，以检查已识别的 这项工作的结果将为卫生系统提供信息。 领导者和政策制定者在 ACO 内实施护理管理策略并考虑变革 这些活动对国家心肺血液部门高度敏感。 研究所的战略目标和目标，特别是目标 6，旨在“优化转化、 旨在改善健康和减少疾病的临床、实施和研究。”