ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies
ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies
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DOI：
10.1097/mlr.0000000000001080
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发表时间：
2019-04-01
期刊：
影响因子：
3
通讯作者：
Chen, Jie
中科院分区：
文献类型：
--
作者：
Anderson, Andrew C.;Chen, Jie
背景资料：由于正式的风险分担和支付安排，附属于责任医疗组织（ACO）的医院可能有更大的能力与整个护理连续体的提供者合作，以协调护理。目的：比较ACO附属医院（n= 269）和非附属医院（n= 502）的护理协调策略的实施情况，并检验护理协调策略的实施是否因医院支付模式的不同而不同。我们构建了一个由12个指标组成的护理协调指数（CCI），这些指标描述了基于证据的护理协调策略。由每家医院的合格代表在5分制李克特量表上对每个指标进行评分，从1=“完全未使用”到5=”广泛使用”。CCI将12个单项指标的得分汇总为每家医院的一个综合得分，12分对应于护理协调策略的最低使用，60分对应于护理协调策略的最高使用。研究设计：我们使用状态固定效应多变量线性回归模型来估计ACO隶属关系、支付模式类型和护理协调策略使用之间的关系。我们发现ACO附属医院报告更多的使用护理协调策略相比，非附属医院。按服务收费的共享储蓄和部分或全球人头支付模式与ACO附属hospitals.Conclusion更多地使用护理协调策略：我们的研究结果表明，ACO的隶属关系和多种支付模式类型与护理协调策略的使用增加。
Background: Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies.Objectives: To compare the implementation of care coordination strategies between ACO affiliated hospitals (n= 269) and unaffiliated hospitals (n= 502) and examine whether the implementation of care coordination strategies varies by hospital payment model types.Measures: We constructed a care coordination index (CCI) comprised of 12 indicators that describe evidence-based care coordination strategies. Each indicator was scored on a 5-point Likert scale from 1= " not used at all" to 5=" used widely" by qualified representatives from each hospital. The CCI aggregates scores from each of the 12 individual indicators to a single summary score for each hospital, with a score of 12 corresponding to the lowest and 60 the highest use of care coordination strategies.Research Design: We used state-fixed effects multivariable linear regression models to estimate the relationship between ACO affiliation, payment model type, and the use care coordination strategies.Results: We found ACO affiliated hospitals reported greater use of care coordination strategies compared to unaffiliated hospitals. Feefor- service shared savings and partial or global capitation payment models were associated with a greater use of care coordination strategies among ACO affiliated hospitals.Conclusion: Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies.