Impact of Medicaid ACO funding for health-related social needs on dietary quality and health

医疗补助 ACO 资助与健康相关的社会需求对饮食质量和健康的影响

基本信息

批准号：
10693118
负责人：
Anne N Thorndike
金额：
$ 49.22万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-17 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10693118
关键词：
Acute Address Adoption Adult Affect Anxiety Behavioral Blood Pressure Body mass index Cardiometabolic Disease Cardiovascular Diseases Caring Chronic Disease Communities Contracts Data Diabetes Mellitus Diet Dietary intake Effectiveness Electronic Health Record Emergency department visit Enrollment Financial Hardship Food Funding Future Glycosylated hemoglobin A Goals Government Health Health system Healthcare Hospitalization Hour Housing Impairment Incentives Insurance Coverage Knowledge Lipids Massachusetts Measures Medicaid Medical Mental Depression Morbidity - disease rate Natural experiment Neighborhood Health Center Nutritional Obesity Outcome Participant Pathway interactions Patients Policies Policy Maker Practical Robust Implementation and Sustainability Model Program Effectiveness Provider Psychological Stress Qualitative Methods Reach, Effectiveness, Adoption, Implementation, and Maintenance Reporting Research Research Personnel Resources Risk Risk Adjustment Self Management Services Social Work Socioeconomic Status Stress Surveys System Time Work accountable care organization cancer health disparity cardiometabolism care delivery dietary effectiveness evaluation flexibility food environment food insecurity health care service organization health care service utilization health organization housing instability implementation barriers implementation determinants implementation evaluation implementation outcomes improved income disparities insight mortality novel patient oriented patient screening payment perceived stress post implementation primary outcome programs screening service organization service programs social social determinants social health determinants

项目摘要

Despite major advances in therapies, disparities in cancer and cardiometabolic outcomes continue to widen due to differences in socioeconomic status. Food and housing insecurity are social determinants of health that are associated with morbidity from obesity, diabetes, cardiovascular disease, and psychological stress, and food insecurity contributes to income disparities in cancer mortality. Although the associations between social needs and health are well-defined, there is a research gap as to whether policies or programs to address food and housing insecurity, particularly through health systems, improve diet, obesity, health, and healthcare utilization. Some states are experimenting with Accountable Care Organizations (ACOs) in their Medicaid programs with the goal of incentivizing providers and organizations to deliver higher value care, and some ACOs are starting to address social needs. In January 2020, the state of Massachusetts will, for the first time, provide funding directly to Medicaid ACOs to address food and housing needs through the Delivery System Reform Incentive Payment Flexible Services program. Implementation of this program is a natural experiment that could provide important knowledge about the impact of state-level funding for food and housing needs on diet and health outcomes. The main objectives of this study are to evaluate how the Flexible Services program affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and to assess program implementation. The project will take place at five community health centers (CHCs) affiliated with Partners HealthCare, a large health care organization that has contracted with the state as a Medicaid ACO. The project is time-sensitive because the pre-program implementation assessment of diet, stress, food/housing insecurity, and access to resources must be completed before program implementation in 2020. A total of 800 Medicaid ACO patients (Med-ACO) and 200 non-Medicaid CHC patients with food/housing insecurity (Control) will be enrolled and followed for 4 years. Survey, 24-hour dietary recall (ASA24), electronic health record (EHR), and claims data will be collected. Primary outcomes will be change in dietary quality, stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health care utilization (emergency department visits; hospitalizations) (Aim 2) comparing: a) Med-ACO participants who screen positive for food/housing insecurity pre-implementation vs. Control, and b) Med-ACO participants who screen positive for food/housing and receive Flexible Services (exposed) vs. Med-ACO participants who screen positive but do not receive Flexible Services (not exposed). Aim 3 will assess implementation factors that influence the effectiveness of the program, guided by the RE-AIM/PRISM framework. Results will inform policymakers and researchers about the effectiveness of a novel state-level program for delivering food and housing resources through Medicaid ACOs and will help refine ongoing and future state and community programs that will reduce income disparities in cancer and cardiometabolic disease.

尽管疗法取得了重大进展，但癌症和心脏代谢结果的差异仍在扩大由于社会经济地位的差异。食物和住房不安全感是健康的社会决定因素与肥胖，糖尿病，心血管疾病和心理压力的发病率有关，以及粮食不安全感导致癌症死亡率的收入差异。尽管社会之间的关联需求和健康定义明确，存在研究差距，即是解决食品的政策还是计划住房不安全感，特别是通过卫生系统，改善饮食，肥胖，健康和医疗保健利用率。一些州正在其医疗补助中尝试负责任的护理组织（ACO）计划激励提供者和组织提供更高的价值护理，有些计划 ACO开始满足社会需求。 2020年1月，马萨诸塞州将首次将直接向医疗补助ACO提供资金，以通过交付系统满足食物和住房需求改革激励付款灵活的服务计划。该程序的实施是一个自然实验这可以提供有关国家一级资金对食品和住房需求的影响的重要知识饮食和健康结果。这项研究的主要目的是评估灵活服务计划如何影响成人ACO参与者的饮食质量，心理压力，健康和医疗保健利用评估计划实施。该项目将在五个社区卫生中心（CHC）举行与Partners Healthcare隶属医疗补助ACO。该项目对时间敏感，因为饮食的计划前实施评估，在计划实施之前，必须在 2020年。共有800名Medicaid ACO患者（MED-ACO）和200名非墨西哥助教CHC患者不安全感（控制）将被招募并遵循4年。调查，24小时饮食召回（ASA24），电子健康记录（EHR），并将收集索赔数据。主要结果将是饮食质量的变化，压力，食物/住房不安全感（AIM 1）和体重指数，血压和急性健康护理利用（急诊室就诊；住院）（目标2）比较：a）MED-ACO参与者谁筛选了食物/住房不安全感的阳性前实用与控制的阳性，b）Med-aco参与者谁筛选食物/住房呈阳性并获得灵活的服务（暴露）与Med-Aco参与者屏幕正面，但没有获得灵活的服务（未暴露）。 AIM 3将评估实施因素这会影响该计划的有效性，并在重新启动/Prism框架的指导下。结果将告知政策制定者和研究人员介绍了一项新型国家级计划在提供食物和的有效性通过医疗补助ACO住房资源，将有助于完善持续和未来的州和社区将减少癌症和心脏代谢疾病的收入差异的计划。