The Effects of Accountable Care Organizations on Disparities in Childhood Asthma Care and Outcomes

负责任的护理组织对儿童哮喘护理和结果差异的影响

基本信息

批准号：
10593159
负责人：
Sarah L Goff
金额：
$ 62.71万
依托单位：
UNIVERSITY OF MASSACHUSETTS AMHERST
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-15 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10593159
关键词：
Accountability Address Adult Affect Age Agonist Asthma COVID-19 pandemic Caring Child Childhood Childhood Asthma Chronic Disease Classification Complex Contracts Data Databases Development Diabetes Mellitus Disease Disparity Emergency department visit Enrollment Environmental Risk Factor Equity Ethnic Origin Evidence based treatment Exposure to Fee-for-Service Plans Health Healthcare Healthy People 2020 Home Home environment Hospitalization Hospitals Human Resources Incentives Inequity Intervention Interview Investments Knowledge Low income Massachusetts Measures Medicaid Medical Methods Modeling Morbidity - disease rate Natural experiment Organizational Models Outcome Outcome Measure Outpatients Ownership Parents Pattern Physicians Policy Maker Population Prevalence Provider Quality Indicator Quality of Care Race Risk Risk Adjustment Risk Factors Schools Site Visit Societal Factors Surveys Taxonomy Technology Testing Time Vulnerable Populations Work accountable care organization clinical care design ethnic disparity ethnic health disparity ethnic minority population evidence base experience experimental study follow-up health care model health care quality health inequalities high risk high risk population hospitalization rates improved improved outcome innovation insurance plan interest long-standing disparities novel organizational structure outcome disparities payment population health programs racial disparity racial health disparity racial minority population scale up social social health determinants socioeconomic disparity socioeconomics urban minority

项目摘要

ABSTRACT Asthma is the most common chronic disease of childhood and causes more preventable hospitalizations and lost school days than any other childhood disease. Children in lower-income, urban, and racial/ethnic minority populations are more likely to have asthma, to have poorly controlled disease, and to experience preventable morbidity. Multi-level interventions that address the complex array of interrelated societal and environmental factors that contribute to these disparities are poorly supported in traditional fee-for-service payment models. In contrast, accountable care organizations (ACOs) are designed to support and sustain interventions that address social determinants of health as part of medical care. A substantial and growing number children with asthma in higher-risk populations receive care in ACOs, but their effect on asthma quality of care, outcomes and disparities is not known. This study will be the first to address this critical gap in knowledge by taking advantage of a natural experiment taking place in Massachusetts (MA), a state with high rates of childhood asthma: In 2018, MA, launched 17 new Medicaid ACOs with varied organizational features (e.g., size; age mix). We will use detailed state-level claims data to: 1) determine the association between implementation of the ACOs and changes in childhood asthma quality indicators, health outcome for Medicaid-insured children and 2) assess changes in socioeconomic and racial/ethnic disparities in these outcome measures comparing children enrolled in Medicaid ACOs to matched commercially-insured children. We then turn to understanding the influence of ACOs’ organizational features on change by: 3) using mixed-methods to generate detailed characterizations of the ACOs’ organizational features and 4) test the association between these features and childhood asthma quality indicators and outcomes. We will use innovative methods of risk adjustment that take social risk factors into account and propensity matched difference- in-difference analyses to account for factors other than ACO implementation that may affect outcomes. This study will take place at a moment when the profound inequities in health and healthcare in the U.S. are starkly illuminated by the COVID-19 pandemic. Socioeconomic and racial/ethnic disparities in childhood asthma persist despite the existence of evidence-based treatments resulting from decades of work and billions of dollars directed at improving asthma care. Structural changes in healthcare are needed for equitable delivery of evidence-based asthma care, which should reduce or even eliminate these long standing disparities. The ACO model moves healthcare payment and delivery in a direction that could facilitate this change. This study will address major gaps in knowledge as to whether the large investments being made in developing the ACO model may pay off for the millions of children at increased risk for long-term poor health due to preventable consequences of asthma.

抽象的哮喘是儿童期最常见的慢性疾病，可导致更多可预防的疾病低收入城市儿童的住院率和缺学率高于任何其他儿童疾病。少数种族/族裔人群更有可能患有哮喘、疾病控制不佳、并体验可预防的发病率，解决一系列复杂的问题。导致这些差异的相互关联的社会和环境因素缺乏支持相比之下，责任医疗组织 (ACO) 是按服务收费的传统支付模式。旨在支持和维持解决健康问题社会决定因素的干预措施，作为高危人群中越来越多的哮喘儿童接受医疗护理。 ACO 的护理，但它们对哮喘护理质量、结果和差异的影响尚不清楚。这项研究将是第一个通过利用自然现象来解决这一知识空白的研究。实验在儿童哮喘发病率较高的马萨诸塞州 (MA) 进行：2018 年， MA 推出了 17 个具有不同组织特征（例如规模、年龄组合）的新医疗补助 ACO。使用详细的州级索赔数据来： 1) 确定实施之间的关联 ACO 和儿童哮喘质量指标的变化、医疗补助保险儿童的健康结果 2）评估这些结果指标中社会经济和种族/民族差异的变化然后我们将参加医疗补助 ACO 的儿童与匹配的商业保险儿童进行比较。通过以下方式了解 ACO 的组织特征对变革的影响：3) 使用混合方法生成 ACO 组织特征的详细特征，并 4) 测试关联我们将在这些特征与儿童哮喘质量指标和结果之间使用创新。考虑社会风险因素和倾向匹配差异的调整风险方法无差异分析以解释 ACO 实施以外可能影响结果的因素。这项研究将在健康和医疗保健领域存在严重不平等的时刻进行。 COVID-19 大流行使美国的社会经济和种族/民族差异暴露无遗。尽管存在数十年的循证治疗，但儿童哮喘仍然存在用于改善哮喘护理的工作和数十亿美元正在发生。公平提供循证哮喘护理所需，这应该减少甚至消除这些长期存在的差异使医疗保健支付和服务朝着一个方向发展。这项研究将解决关于是否存在巨大的知识差距。开发 ACO 模型的投资可能会为数百万儿童带来回报由于哮喘的可预防后果，导致长期健康状况不佳的风险增加。