Value-based Purchasing in Implementation of Depression Care in Community Clinics

基于价值的采购在社区诊所抑郁症护理实施中的应用

基本信息

批准号：
9098799
负责人：
Yuhua Bao
金额：
$ 42.42万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
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：
2014-08-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9098799
关键词：
Accident and Emergency department Accounting Adopted Adoption American Area Beryllium Caring Chronic Care Chronic Disease Clinic Communities Community Health Contracts County Data Databases Effectiveness Elements Enrollment Environment Funding Future Goals Health Health Care Costs Health Insurance Healthcare Hospitalization Incentives Knowledge Learning Link Low income Measures Mediating Mediator of activation protein Medicare Mental Depression Mental Health Modeling Natural experiment Outcome Patient-Focused Outcomes Patients Performance Phase Policies Population Primary Health Care Process Provider Registries Resources Role Source Specific qualifier value Time Uninsured Update Washington base behavioral health behavioral response burden of illness collaborative care cost depressive symptoms design evidence base health care service utilization health organization improved improved outcome learning progression meetings patient population payment population health programs psychosocial response tool

项目摘要

DESCRIPTION (provided by applicant): As many as 40 million low-income Americans will rely on community health clinics (CHCs) for primary care by 2019. Depression and other behavioral health conditions are a major source of disease burden in this population. Implementation of evidence-based behavioral health care is a priority area for CHCs. The goal of this study is to assess the role of Value-Based Purchasing (VBP), a policy strategy, to enhance planned implementation of evidence-based care in CHCs. VBP is a tool to spur quality improvement by linking payment to provider organizations with pre-specified performance targets. The proposed study will leverage a unique VBP program initiated by the Washington State Mental Health Integration Program (MHIP). MHIP implements the Collaborative Care model, a prominent, evidence-based model to integrate behavioral health care into primary care. MHIP's multi-phase VBP embeds several desirable design features and offers a rare opportunity to produce generalizable findings on the effectiveness of VBP to support implementation of evidence-based chronic care. We will conduct retrospective analysis of existing data based on MHIP registry and health care claims of over 12,000 patients from 52 CHCs in Washington State's King and Pierce Counties. Aims of the study are to assess the effects of MHIP VBP on: 1. Adoption of Collaborative Care by CHCs; and, 2. Patient outcomes. We will measure adoption based on CHC performance of key process-of-care elements of Collaborative Care at the patient-episode level. Patient outcomes include depression symptoms, hospitalization, emergency room use and total health care costs. Our analytical strategy will exploit the natural experiment created by the rolling enrollment of patients into MHIP. Specifically, we will compare outcomes pertaining to patient-episodes that occurred pre-, peri-, and post- VBP while controlling for the continuous learning and adopting processes at CHCs. Preliminary data suggest overall low adoption pre-VBP, substantial improvement over time, and CHC behavioral responses to VBP incentives that are consistent with the conceptual framework of the proposed study. This study will generate critical knowledge to assist policymakers with their decisions on whether to use VBP to enhance implementation of evidence-based care in CHCs and how to best design VBP to maximize its impact.

描述（由申请人提供）：到 2019 年，多达 4000 万低收入美国人将依靠社区卫生诊所 (CHC) 获得初级保健。抑郁症和其他行为健康状况是该人群疾病负担的主要来源。实施循证行为卫生保健是社区卫生中心的优先领域。本研究的目的是评估基于价值的采购 (VBP) 这一政策策略的作用，以加强社区卫生中心循证护理的计划实施。 VBP 是一种通过将付款与具有预先指定的绩效目标的提供商组织联系起来来刺激质量改进的工具。拟议的研究将利用华盛顿州心理健康整合计划 (MHIP) 发起的独特 VBP 计划。 MHIP 实施协作护理模式，这是一种著名的循证模型，将行为健康护理纳入初级护理。 MHIP 的多阶段 VBP 嵌入了几个理想的设计功能，并提供了一个难得的机会，可以得出有关 VBP 有效性的普遍发现，以支持实施循证慢性病护理。我们将根据 MHIP 登记和来自华盛顿州金县和皮尔斯县 52 个 CHC 的 12,000 多名患者的医疗保健索赔的现有数据进行回顾性分析。该研究的目的是评估 MHIP VBP 对以下方面的影响： 1. CHC 采用协作护理； 2. 患者结果。我们将根据 CHC 在患者层面对协作护理的关键护理流程要素的表现来衡量采用情况。患者结果包括抑郁症状、住院治疗、急诊室使用和总医疗费用。我们的分析策略将利用自然实验患者滚动入组 MHIP。具体来说，我们将比较 VBP 之前、期间和之后发生的患者发作的结果，同时控制 CHC 的持续学习和采用过程。初步数据表明，VBP 之前整体采用率较低，但随着时间的推移，CHC 对 VBP 激励措施的行为反应显着改善，这与拟议研究的概念框架一致。这项研究将产生关键知识，帮助政策制定者决定是否使用 VBP 来加强社区卫生中心循证护理的实施，以及如何最好地设计 VBP 以最大限度地发挥其影响。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state.

实施循证护理中的基于价值的支付：华盛顿州的心理健康整合计划。

DOI：
发表时间：
2017
期刊：
The American journal of managed care
影响因子：
0
作者：
Bao,Yuhua;McGuire,ThomasG;Chan,Ya-Fen;Eggman,AshleyA;Ryan,AndrewM;Bruce,MarthaL;Pincus,HaroldAlan;Hafer,Erin;Unützer,Jürgen
通讯作者：
Unützer,Jürgen