Impact of Medicaid ACO funding for health-related social needs on dietary quality and health

医疗补助 ACO 资助与健康相关的社会需求对饮食质量和健康的影响

• 批准号: 10249260
• 负责人: Anne N Thorndike
• 金额: $ 64.92万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-17 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10249260
• 关键词: Acute; Address; Adoption; Adult; Affect; Anxiety; Behavioral; Blood Pressure; Body mass index; Cardiometabolic Disease; Cardiovascular Diseases; Caring; Chronic Disease; Communities; Contracts; Data; Diabetes Mellitus; Diet; Dietary Assessment; Dietary intake; Effectiveness; Electronic Health Record; Emergency department visit; Enrollment; Financial Hardship; Food; Funding; Future; Glycosylated hemoglobin A; Goals; Government; Health; Health system; Healthcare; Hospitalization; Hour; Housing; Impairment; Incentives; Insurance Coverage; Knowledge; Lead; Lipids; Massachusetts; Measures; Medicaid; Medical; Mental Depression; Morbidity - disease rate; Natural experiment; Neighborhood Health Center; Nutritional; Obesity; Outcome; Participant; Pathway interactions; Patients; Policies; Practical, Robust Implementation and Sustainability Model; Program Effectiveness; Provider; Psychological Stress; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Personnel; Resources; Risk; S-nitro-N-acetylpenicillamine; Self Management; Services; Social Work; Socioeconomic Status; Stress; Surveys; System; Time; Work; cancer health disparity; cardiometabolism; care delivery; dietary; effectiveness evaluation; experimental study; flexibility; food environment; food insecurity; health care service organization; health care service utilization; health organization; housing instability; implementation determinants; implementation outcomes; improved; income disparities; insight; mortality; novel; patient oriented; patient screening; payment; perceived stress; primary outcome; programs; screening; service organization; service programs; social; social determinants; social health determinants; social organization

Despite major advances in therapies, disparities in cancer and cardiometabolic outcomes continue to widen due to differences in socioeconomic status. Food and housing insecurity are social determinants of health that are associated with morbidity from obesity, diabetes, cardiovascular disease, and psychological stress, and food insecurity contributes to income disparities in cancer mortality. Although the associations between social needs and health are well-defined, there is a research gap as to whether policies or programs to address food and housing insecurity, particularly through health systems, improve diet, obesity, health, and healthcare utilization. Some states are experimenting with Accountable Care Organizations (ACOs) in their Medicaid programs with the goal of incentivizing providers and organizations to deliver higher value care, and some ACOs are starting to address social needs. In January 2020, the state of Massachusetts will, for the first time, provide funding directly to Medicaid ACOs to address food and housing needs through the Delivery System Reform Incentive Payment Flexible Services program. Implementation of this program is a natural experiment that could provide important knowledge about the impact of state-level funding for food and housing needs on diet and health outcomes. The main objectives of this study are to evaluate how the Flexible Services program affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and to assess program implementation. The project will take place at five community health centers (CHCs) affiliated with Partners HealthCare, a large health care organization that has contracted with the state as a Medicaid ACO. The project is time-sensitive because the pre-program implementation assessment of diet, stress, food/housing insecurity, and access to resources must be completed before program implementation in 2020. A total of 800 Medicaid ACO patients (Med-ACO) and 200 non-Medicaid CHC patients with food/housing insecurity (Control) will be enrolled and followed for 4 years. Survey, 24-hour dietary recall (ASA24), electronic health record (EHR), and claims data will be collected. Primary outcomes will be change in dietary quality, stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health care utilization (emergency department visits; hospitalizations) (Aim 2) comparing: a) Med-ACO participants who screen positive for food/housing insecurity pre-implementation vs. Control, and b) Med-ACO participants who screen positive for food/housing and receive Flexible Services (exposed) vs. Med-ACO participants who screen positive but do not receive Flexible Services (not exposed). Aim 3 will assess implementation factors that influence the effectiveness of the program, guided by the RE-AIM/PRISM framework. Results will inform policymakers and researchers about the effectiveness of a novel state-level program for delivering food and housing resources through Medicaid ACOs and will help refine ongoing and future state and community programs that will reduce income disparities in cancer and cardiometabolic disease.

尽管治疗方法取得了重大进展，但癌症和心脏代谢结果的差异仍在扩大 由于社会经济地位的差异。粮食和住房不安全是健康的社会决定因素 与肥胖、糖尿病、心血管疾病和心理压力的发病率有关，并且 粮食不安全导致癌症死亡率的收入差距。尽管社会之间的联系 需求和健康已明确界定，但关于是否有政策或计划解决粮食问题还存在研究空白 和住房不安全，特别是通过卫生系统，改善饮食、肥胖、健康和医疗保健 利用率。一些州正在其医疗补助中尝试责任医疗组织 (ACO) 旨在激励提供者和组织提供更高价值护理的计划，以及一些 ACO 开始满足社会需求。 2020 年 1 月，马萨诸塞州将首次， 直接向医疗补助 ACO 提供资金，通过交付系统满足食品和住房需求 改革奖励支付灵活服务计划。这个计划的实施是一个自然的实验 这可以提供有关国家一级为粮食和住房需求提供资金的影响的重要知识 饮食和健康结果。本研究的主要目的是评估灵活服务计划如何 影响成年 ACO 参与者的饮食质量、心理压力、健康和医疗保健利用， 评估计划的实施情况。该项目将在五个社区卫生中心 (CHC) 进行 隶属于 Partners HealthCare，这是一家大型医疗保健组织，已与该州签约作为 医疗补助 ACO。该项目具有时间敏感性，因为项目实施前的饮食评估、 在计划实施之前，必须先解决压力、粮食/住房不安全和资源获取问题 2020 年。总共 800 名医疗补助 ACO 患者 (Med-ACO) 和 200 名非医疗补助 CHC 患者获得食物/住房 不安全感（对照）将被登记并跟踪 4 年。调查，24 小时饮食回忆 (ASA24)，电子 将收集健康记录 (EHR) 和索赔数据。主要结果将是饮食质量的改变， 压力、食物/住房不安全（目标 1）以及体重指数、血压和急性健康状况的变化 护理利用（急诊科就诊；住院治疗）（目标 2）比较： a) Med-ACO 参与者 实施前与对照相比，食品/住房不安全筛查呈阳性的人，以及 b) Med-ACO 参与者 食物/住房筛查呈阳性并接受灵活服务（暴露）的人与 Med-ACO 参与者 筛查呈阳性但未接受灵活服务（未暴露）。目标 3 将评估实施因素 在 RE-AIM/PRISM 框架的指导下，影响项目有效性的因素。结果将告知 政策制定者和研究人员了解一项新的国家级粮食供应计划的有效性 通过医疗补助 ACO 获得住房资源，将有助于完善当前和未来的州和社区 将减少癌症和心脏代谢疾病方面的收入差距的计划。