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.

抽象的哮喘是最常见的儿童慢性疾病，可预防与任何其他儿童疾病相比，住院和上学时间失去。低收入的孩子，城市，种族/族裔少数民族更有可能患有哮喘，控制疾病不良，并体验可预防的发病率。多级干预措施，以解决复杂数组有助于这些差异的相互关联的社会和环境因素受到支持在传统的费用支付付款模型中。相比之下，负责任的护理组织（ACO）是旨在支持和维持针对健康社会决定者的干预措施，作为医疗。高危人群中哮喘的大量和成长中的儿童接受 ACO的护理，但尚不清楚它们对哮喘护理，结果和差异的影响。这项研究将是第一个通过利用自然的优势来解决知识的关键差距在马萨诸塞州（马萨诸塞州）进行的实验，这是一个童年哮喘患病率高的州：2018年， MA，推出了17个具有各种组织功能（例如，大小；年龄组合）的新医疗补助ACO。我们将使用详细的州级索赔数据至：1）确定实施之间的关联 ACOS和儿童哮喘质量指标的变化，医疗补助儿童的健康结果 2）评估这些成果措施中社会经济和种族/种族差异的变化比较参加医疗补助ACO的儿童与商业保险的儿童相匹配。然后我们转了解ACO的组织特征对变更的影响：3）使用混合方法为了生成ACO的组织特征的详细字符，4）测试协会在这些功能和童年期哮喘质量指标和结果之间。我们将使用创新考虑到社会风险因素并承诺与差异相匹配的风险调整方法 - 差异分析以说明可能影响结果的ACO实施因素。这项研究将在卫生和医疗保健中的深刻不平等现象中进行美国的大流行充满了敏锐的照亮。社会经济和种族/种族差异尽管存在数十年工作和数十亿美元用于改善哮喘护理。医疗保健的结构变化是公平交付基于证据的哮喘护理所需的需要减少甚至消除这些长期存在的差异。 ACO模型将医疗保健付款和交付方向移动这可以促进这一变化。这项研究将解决知识的主要差距用于开发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，长期健康状况不佳的风险增加。