Exploring Medicare Provider Networks: Implications for Adoption of CER Findings

探索医疗保险提供者网络：采用 CER 研究结果的影响

• 批准号: 8212742
• 负责人: Jay Bhattacharya
• 金额: $ 24.66万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8212742
• 关键词: Adopted; Adoption; Affect; Area; Cardiac; Caring; Characteristics; Chronic; Chronic Care; Clinical; Coronary; Data; Diabetes Mellitus; Evidence based practice; Expenditure; Future; Geographic Locations; Geography; Goals; Growth; Health; Health Expenditures; Healthcare; Long-Term Care; Medical; Medicare; Medicare claim; Minority; Myocardial Ischemia; Outcome; Outcomes Research; Patients; Patterns of Care; Physicians; Policies; Population; Procedures; Provider; Publications; Publishing; Research; Savings; Seminal; Social Network; Specialist; Stents; Structure; Surgeon; Testing; Time; Variant; Woman; Work; base; clinical practice; cohort; comparative effectiveness; cost; cost effective; design; effectiveness research; evidence base; improved; payment; response; virtual

DESCRIPTION (provided by applicant): If comparative effectiveness research (CER) is to reduce health expenditure growth without compromising health outcomes, providers will need to adopt long-term cost-saving strategies that are identified as being no less effective than higher-cost clinical strategies. Understanding how provider "virtual" networks for Medicare influence the cost and content of care may be important when considering health reforms designed to promote the use of lower-cost effective medical care. We propose identifying factors that determine or influence the use of cost-saving yet effective clinical strategies. We further propose investigating the influence of Medicare provider networks (virtual or social networks) and their structure on the cost and content (e.g., evidence-based practices or not) of care provided. Our specific aims are to: 1) determine the extent to which supply and demand factors predict provider adoption of cost-saving evidence-based findings, 2) analyze provider network structure for differences in and influence on the use of evidence-based practices and costs of care, 3) estimate potential Medicare expenditure savings based on policies implementing these findings (perhaps through the use of payment or health reforms such as bundled payments or ACOs). We will base our analysis on the complete Medicare claims files for Parts A and B from years 2005 to 2010 and Part D from 2006 to 2010. Specifically, we will apply these aims to the treatment of patients with chronic stable angina and the use of revascularization with coronary stents before and after evidence-based findings (the COURAGE trial in 2007) were published supporting the initial use of medical management. We will identify the relevant cohort from the Medicare claims files for the time period before and after the time of publication, and identify factors that predicted a change in provider practices from revascularization with stents to medical management in the data. We will control for demographic and patient-level characteristics, investigate ecological and supply determinants, and investigate differences across geographies and patient sub-populations such as women, minorities, and those with diabetes. Next, we will identify provider networks of care for chronic stable angina in the Medicare data, and explore whether provider network structure influences the cost or content of care provided (concordant with evidence-based practices or not). We will explore whether network structures differ across geographies, and whether this partially explains the difference in practice variation and cost between regions. We will identify ways that our findings might be integrated into health reform policies either to optimize the factors we identify as determinants of low-cost yet effective care or to encourage efficient provider network formation. Finally, we will estimate potential Medicare savings based upon these policies. PUBLIC HEALTH RELEVANCE: This project identifies factors that influence provider adoption of evidence-based, cost-saving clinical practices. It investigates the influence of "virtual" provider networks on the use of evidence-based practices and costs of care in the Medicare population, and explores how these findings could be used in health reform policies to promote evidence-based, efficient patterns of care.

描述（由申请人提供）：如果比较有效性研究（CER）是为了减少健康支出增长而不会损害健康结果，则提供者将需要采用长期省钱的策略，而这些策略被确定为不如更高成本的临床策略。在考虑旨在促进使用低成本有效医疗服务的医疗改革时，了解提供者“虚拟”网络如何影响医疗保健的成本和内容可能很重要。 我们建议确定决定或影响省略成本但有效临床策略的使用因素。我们进一步建议调查医疗保险提供商网络（虚拟或社交网络）及其对提供的成本和内容（例如，是否基于证据的实践）的影响。我们的具体目的是：1）确定供求因素在多大程度上预测提供者采用节省成本的基于证据的发现，2）分析提供商网络结构，以确定基于证据的实践和护理成本的使用和对使用基于证据的实践和成本的差异，3）估计基于实施这些发现的政策的潜在医疗保险支出节省（也许是通过付款或付款或保健付款的使用）或ACOS付费或ACOS付费或ACOS的ACOS或ACOS。 我们将对从2005年到2010年的完整Medicare索赔文件以及2006年至2010年的D部分进行分析。具体来说，我们将将这些目标应用于慢性稳定心绞痛的患者的治疗，并在基于证据的发现（2007年勇气试验）（2007年的勇气试验）中使用冠状动脉支架（2007年的Corrage Exections）发表了支持医疗管理的初步管理。我们将在发表之前和之后的Medicare索赔文件中确定相关的队列，并确定预测数据中提供者实践变化的因素，从血管形成和数据中的医疗管理中的医疗管理变化。我们将控制人口统计学和患者水平的特征，研究生态和供应决定因素，并调查跨地理位置以及患者亚人群的差异，例如妇女，少数民族和患有糖尿病患者。接下来，我们将确定医疗保险数据中慢性稳定心绞痛的提供者护理网络，并探讨提供商网络结构是否影响提供的护理成本或内容（与循证实践一致）。我们将探索网络结构在各个地理之间是否有所不同，以及这部分解释了区域之间实践变化和成本的差异。我们将确定我们的发现可能被整合到健康改革政策中，以优化我们确定为低成本但有效护理的决定因素，或者鼓励有效的提供商网络形成。最后，我们将根据这些政策估算潜在的Medicare储蓄。 公共卫生相关性：该项目确定了影响提供者采用基于证据的，节省成本的临床实践的因素。它调查了“虚拟”提供商网络对医疗保险人群中基于证据的实践和护理成本的使用的影响，并探讨了如何在医疗改革政策中使用这些发现来促进基于证据的，有效的护理模式。