Integrated health systems, market concentration, and socioeconomic disparities in quality of care

综合卫生系统、市场集中度和护理质量方面的社会经济差异

• 批准号: 10265502
• 负责人: Justin W. Timbie
• 金额: $ 40万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265502
• 关键词: Integrated; health; systems; market; concentration

Project Summary/Abstract Americans at opposite ends of the socioeconomic spectrum differ in life expectancy by 10 to 15 years. Socioeconomic status (SES) and other social determinants of health (SDOH), such as employment, stable housing, and access to healthy food, explain much of these differences. However, numerous studies also show that low-income patients receive worse medical care than high-income patients across a wide range of quality measures. Many low-SES patients receive care from physician organizations (POs) that have fewer resources to care for patients with complex health and social needs, including multidisciplinary care teams and advanced health information technology, compared with POs serving higher-income patients. Meanwhile, integrated health systems, health care organizations that own both hospitals and POs, are expanding across the country with potentially far-reaching changes in how medical care is delivered. POs owned by health systems may be well-positioned to support initiatives that address SDOH through access to capital that could support infrastructure improvements, better access to specialty care for their patients, and better coordination across care settings. However, prior studies have shown that health system-ownership of POs has little to no effect on quality, is associated with higher spending, and may lead to worse patient experiences. It is not known whether POs that treat low SES patients are joining health systems or how health system ownership affects care for low SES patients. The specific aims of this study are to: (1) assess trends in health system ownership of POs that serve patients with low SES; (2) assess the impact of health system ownership of POs on SES disparities in access to care and quality of care; (3) decompose the effects of ownership changes on SES disparities into within-PO and between-PO effects; and (4) identify mechanisms through which health system-owned POs and independent POs achieve reductions in SES disparities. The proposed study builds on research conducted by the investigators as part of an AHRQ-funded Center of Excellence on Health System Performance that explored the impact of hospital ownership changes on quality of care, racial and ethnic differences in quality of care between heath system-owned POs and independent POs, and efforts to achieve clinical integration by safety net providers. The study will provide policymakers with timely information about the potential benefits or unintended consequences for vulnerable populations of PO ownership by health systems and the role of physician market concentration and other market characteristics in explaining trends in SES disparities. Primary data collection from 30 POs and their community partners will identify the specific strategies that POs are using to reduce SES disparities and to determine the value added of health system ownership.

项目概要/摘要 处于社会经济阶层两端的美国人的预期寿命相差 10 到 15 年。 社会经济地位 (SES) 和其他健康社会决定因素 (SDOH)，例如就业、稳定 住房和健康食品的获取在很大程度上解释了这些差异。然而大量研究也表明 低收入患者在各方面的医疗质量都比高收入患者差 措施。许多社会经济地位低的患者接受资源较少的医生组织 (PO) 的护理 照顾具有复杂健康和社会需求的患者，包括多学科护理团队和先进的 与服务高收入患者的 PO 相比，健康信息技术。同时，综合 卫生系统、同时拥有医院和 PO 的卫生保健组织正在全国范围内扩张 医疗服务的提供方式可能会发生深远的变化。卫生系统拥有的 PO 可能是 处于有利地位，可以通过获得可支持的资本来支持解决 SDOH 的倡议 基础设施的改善、患者更好地获得专业护理以及更好的协调 护理设置。然而，先前的研究表明，卫生系统拥有 PO 几乎没有影响 质量，与更高的支出相关，并可能导致更差的患者体验。尚不清楚是否 治疗低社会经济地位患者的 PO 正在加入卫生系统，或者卫生系统所有权如何影响低社会经济地位患者的护理 SES 患者。本研究的具体目的是：(1) 评估卫生系统拥有 PO 的趋势， 为社会经济地位低的患者提供服务； (2) 评估卫生系统拥有 PO 对社会经济地位差异的影响 获得护理的机会和护理质量； (3) 将所有权变更对社会经济地位差异的影响分解为 PO 内和 PO 间效应； (4) 确定卫生系统拥有的 PO 和 独立的 PO 实现了社会经济地位差距的缩小。拟议的研究建立在以下研究的基础上： 研究人员作为 AHRQ 资助的卫生系统绩效卓越中心的一部分 探讨了医院所有权变化对护理质量的影响以及医疗质量的种族和民族差异 卫生系统拥有的 PO 和独立 PO 之间的护理，以及努力实现临床整合 安全网提供者。该研究将为政策制定者提供有关潜在利益或利益的及时信息 卫生系统拥有 PO 对弱势群体造成的意外后果以及 医生市场集中度和其他市场特征解释了社会经济地位差异的趋势。 从 30 个 PO 及其社区合作伙伴收集的主要数据将确定 PO 的具体策略 用于减少社会经济地位差距并确定卫生系统所有权的附加值。