The Impact of Health Care Reform on Addiction and HIV Services

医疗保健改革对成瘾和艾滋病毒服务的影响

基本信息

批准号：
8823048
负责人：
CYNTHIA I CAMPBELL
金额：
$ 43.76万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-05-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8823048
关键词：
Affect Benchmarking CD4 Lymphocyte Count California Caring Characteristics Clinic Clinical Comorbidity Computerized Medical Record Cost Sharing Data Deductibles Demographic Accounting Diagnosis Diagnostic Services Elements Enrollment Future HIV HIV Seropositivity Health Health Care Costs Health Care Reform Health Insurance Health Planning Health Policy Health Services Health Services Accessibility Healthcare Healthcare Systems Individual Inpatients Interview Measures Mediating Medicaid Medical Methods Organizational Change Organizational Models Outcome Patients Pattern Phase Registries Route Sampling Services Silver Socioeconomic Status Statutes and Laws Substance Use Disorder System Time Treatment Cost Viral Vulnerable Populations Work addiction base cohort cost demographics design health care delivery health care service utilization implementation research improved innovation member patient population response screening service utilization theories

项目摘要

Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plans extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.

医疗改革立法对获得服务和扩展具有重大影响患有药物使用障碍的人（SUD），尤其是患有艾滋病毒的人。这些条件是与多种医学和精神病合并症以及高医疗保健费用相关。回应 RFA-DA-13-001，拟议的研究重点是《平价医疗法案》（ACA）的关键要素于2014年实施，可能会增加对SUD和HIV治疗服务的需求。研究评估 ACA对ACA实施研究非常适合护理环境中SUD的人的影响。 Kaiser Permanente北加州（KPNC）是一个大型医疗保健系统，可提供综合的SUD和医疗治疗已被指定为加利福尼亚州小组计划的全州基准健康保险交换。我们的创新方法由一个综合的概念模型告知组织理论和卫生服务利用。在这项分阶段研究中，R21相的目的是分析会员人口统计和临床复杂性，服务使用和临床复杂性变化的基础工作费用，使用新入学的ACA Pre-ACA健康计划成员（包括成员）的队列（n = 3641）与泡沫和艾滋病毒一起。在R33阶段，我们使用前post设计将R21队列与第二个相提并论使用高级差异差异，新入学的KPNC成员的ACA群体队列分析2014年开始ACA相关变化的方法。关键结果包括会员更改，卫生服务利用和成本，SUD治疗启动和保留以及艾滋病毒管理。职位 - 在两年内，ACA队列也将纵向遵循。采用创新的混合方法方法，我们使用健康计划中广泛的电子病历中的数据，并补充了定性访谈组织和临床领导者涉及与ACA相关的变更，以使计划，服务交付，影响ACA实施的劳动力以及障碍或促进者。调查结果将有很高的信息了解健康计划如何实施ACA并为新保险的SUD和HIV患者服务人口，并将为未来的健康政策做出贡献。