The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians
The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians
复制标题
DOI：
10.1377/hlthaff.2017.1678
复制
发表时间：
2018-06-01
期刊：
影响因子：
9.7
通讯作者：
Brown, Randall S.
中科院分区：
文献类型：
--
作者：
Peikes, Deborah;Dale, Stacy;Brown, Randall S.
综合初级保健倡议（CPC）是由医疗保险和医疗补助服务中心（CMS）开发的一种医疗保健服务模式，它测试了全国502个初级保健实践的多付款人支持是否会改善初级保健服务，提高护理质量，或减少支出。我们评估了该计划对医疗服务提供的影响，以及与那些归因于匹配比较实践的医疗服务收费受益人的结果。CPC实践报告了初级保健服务的改善，包括对高危患者的护理管理，提高了可及性，并改善了护理过渡的协调。与比较做法相比，该举措使CPC做法中急诊科就诊人数的增长放缓了2%。然而，它并没有减少足够的医疗保险支出来支付护理管理费，也没有明显改善医生或受益人的经验或在有限的医疗保险索赔质量措施上的实践表现。随着CMS和其他支付方越来越多地使用奖励质量和价值的替代支付模式，CPC在支持医疗改革实践方面提供了重要经验。
The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.