New York State Health Home Impact on HIV Treatment Cascade

纽约州健康之家对艾滋病毒治疗级联的影响

基本信息

批准号：
8771003
负责人：
JON MORGENSTERN
金额：
$ 67.16万
依托单位：
PARTNERSHIP TO END ADDICTION
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8771003
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Anti-Retroviral Agents Behavioral Bipolar Disorder Caring Case Manager Characteristics Chronic Disease Client Clinical Continuity of Patient Care Contracts Country Data Data Set Drug Metabolic Detoxication Effectiveness Enrollment Glycosylated hemoglobin A HIV HIV Seropositivity Health Health Care Costs Health Care Reform Health Personnel Health Services Accessibility Healthcare Healthcare Systems High Prevalence Home environment Homeless persons Homelessness Housing Human immunodeficiency virus test Indigent Individual Infection Inpatients Intervention Studies Knowledge Life Low income Measures Medicaid Medical Mental Health Mental disorders Methods Metric Mood stabilizers Nature New York Outcome Paint Participant Patients Persons Policies Population Provider Public Health Public Sector Qualitative Research Quality of Care Quality of life Regimen Reporting Research Research Methodology Risk Series Services Social Work Substance Use Disorder System Technology Testing Time United States Viral Viral Load result antiretroviral therapy behavioral health care systems compliance behavior cost diabetic evidence base housing instability improved longitudinal design medication compliance novel strategies programs public health relevance social stem supported housing surveillance data transmission process

项目摘要

DESCRIPTION (provided by applicant): In order to slow the spread of HIV and improve health outcomes for persons living with HIV/AIDS (PLWHA), the Affordable Care Act greatly expands access to health care for low-income PLWHA. Further, the Office of National AIDS Policy has created a strategy to improve the current system of care by closing gaps in the HIV care continuum. The HIV care continuum outlines a series of steps in addressing infection: a) HIV testing, b) engagement in HIV care, c) participation in antiretroviral therapy (ART), and d) the ultimate target-viral suppression. Surveillance data paint a dismal picture of the continuum of care in the United States, with less than 25% of PLWHA having undetectable viral load. Given the fragmented, crisis-driven nature of the current health care system, individuals who are homeless or unstably housed may continue to receive low quality care or no care at all. The high prevalence of substance use disorders, mental illness, and other chronic illnesses among unstably housed, HIV-positive individuals increases the difficulty in engaging this group in care. The Affordable Care Act includes a number of important healthcare system restructuring provisions for chronic illness management, among which are Health Homes (HH) for Medicaid recipients. New York (NY) Department of Health (DOH) has created one of the country's earliest and most ambitious implementations of HHs. NY HH's are newly formed integrated healthcare networks of medical and behavioral health providers that contract to provide integrated care through shared care managers and common technology platforms. Additionally, NY DOH has a pilot program to provide 544 units of supportive housing (SH) for homeless PLWHA enrolled in HHs. This study will test 1) whether SH combined with HHs improves quality of care for 544 homeless PLWHA HH enrollees and 2) whether New York HH improve quality of care and costs to 8,250 Medicaid homeless PLWHA enrolled in HHs. The primary aims will be addressed in two ways. First, we will compare HIV continuum and other quality metrics and Medicaid costs between homeless PLWHA in SH and those who did not receive supportive housing using nonparametric difference-in-difference methods. Second, we will implement a longitudinal design using administrative data from 2009 through 2016 to examine changes in quality of care and Medicaid costs for homeless PLWHA in Medicaid. The project comes from an academic- public sector partnership to address high priority questions of healthcare system redesign. Data will come from surveillance data on all HIV lab tests conducted in NY, Medicaid encounters/claims, and from HHs reporting on client functioning and care manager contacts. These data will be merged to create DE identified analytical datasets by DOH. Additional qualitative research methods will be employed to elucidate the HH factors associated with outcomes. If aims are achieved, the study is likely to have a major impact on improving knowledge about evidence-based approaches to address homeless PLWHA. In addition, because the study intervention is part of ACA, the policy impact of the study findings on national healthcare may be substantial.

描述（由申请人提供）：为了减缓艾滋病毒的传播并改善艾滋病毒/艾滋病患者（PLWHA）的健康成果，《平价医疗法案》大大扩展了低收入PLWHA的医疗保健机会。此外，国家艾滋病政策办公室已经制定了一项战略，通过缩小艾滋病毒护理连续体的差距来改善当前的护理体系。艾滋病毒护理连续体概述了解决感染的一系列步骤：a）艾滋病毒测试，b）参与艾滋病毒护理，c）参与抗逆转录病毒疗法（ART），d）最终的靶标抑制。监视数据描绘了美国连续护理的令人沮丧的情况，不到25％的PLWHA具有无法检测到的病毒负荷。鉴于当前的医疗保健系统的碎片，危机驱动的性质，无家可归或不稳定的人可能会继续接受低质量的护理或根本没有护理。在不稳定的住所中，艾滋病毒阳性的个体的物质使用障碍，精神疾病和其他慢性疾病的高流行率增加了吸引该群体从事护理的困难。《负担得起的护理法》包括许多重要的医疗保健系统重组规定，用于慢性疾病管理，其中包括医疗补助接收者的卫生屋（HH）。纽约（纽约）卫生部（DOH）创建了该国最早，最雄心勃勃的HHS实施之一。纽约HH是新成立的医疗和行为健康提供者的综合医疗网络，它们合同通过共享护理经理和通用技术平台提供综合护理。此外，纽约DOH还有一个试点计划，可为参加HHS的无家可归者PLWHA提供544个支持住房（SH）。这项研究将测试1）SH与HHS结合是否可以提高544个无家可归者HH参与者的护理质量，以及2）纽约HH是否将护理质量和成本提高到8,250 Medicaid无家可归者PLWHA，参加了HHS。主要目标将通过两种方式解决。首先，我们将比较SH的无家可归者PLWHA与未使用非参数差异差异方法获得支持性住房的人之间的HIV连续性和其他质量指标和医疗补助成本。其次，我们将使用2009年至2016年的行政数据实施纵向设计，以检查医疗补助中无家可归者PLWHA的护理质量和医疗补助成本的变化。该项目来自学术公共部门的合作伙伴关系，以解决重新设计医疗保健系统的高优先问题。数据将来自有关纽约州进行的所有艾滋病毒实验室测试的监视数据，医疗补助遭遇/索赔，以及有关客户端功能和护理经理联系人的HHS报告。这些数据将合并以通过DOH创建DE确定的分析数据集。将采用其他定性研究方法来阐明与结果相关的HH因子。如果实现目标，则该研究可能会对改善有关循证方法的知识的知识产生重大影响，以解决无家可归的PLWHA。此外，由于研究干预是ACA的一部分，因此研究结果对国家医疗保健的政策影响可能很大。