Emergency Department Involvement in Accountable Care Organizations in Massachusetts: A Survey Study
Emergency Department Involvement in Accountable Care Organizations in Massachusetts: A Survey Study
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DOI：
10.1016/j.annemergmed.2017.06.040
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发表时间：
2017-11-01
影响因子：
6.2
通讯作者：
Smulowitz, Peter B.
中科院分区：
文献类型：
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作者：
Ali, Nissa J.;McWilliams, J. Michael;Smulowitz, Peter B.
研究目标：我们评估马萨诸塞州急诊科 (ED) 的参与以及责任护理组织合同中的内部 ED 结构。 方法：向 70 名马萨诸塞州急诊科主任分发了一项在线调查。问题试图评估急诊科对责任医疗组织的参与以及急诊科的现有结构（从部门资源到医生激励措施），以帮助实现责任医疗组织减少支出和提高质量的目标。 结果：在受访的急诊科主任中，79% 的人报告说急诊科与责任医疗组织之间保持一致。几乎所有 ED 团体 (88%) 均表示，其组织参与的责任医疗组织合同不存在财务风险。实现责任医疗组织目标的主要障碍包括护理协调挑战（62%）和对责任医疗组织目标缺乏熟悉（58%）。最常见的降低成本策略包括急诊病例管理（85%）和信息技术（61%）。这项研究的局限性包括信息由急诊科主任自行报告，重点仅限于马萨诸塞州，调查回复率为 47%。 结论：急诊科主任认为大多数医生不熟悉责任医疗组织的目标，在协调急诊科患者的护理方面仍然存在许多挑战，并且大多数急诊科没有与责任医疗组织相关的经济激励措施。马萨诸塞州的急诊室已开始实施旨在减少入院率、利用率和总体成本的策略，但除了病例管理之外，这些策略并未广泛普及，即使在责任护理组织渗透率很高的州也是如此。我们的结果表明，马萨诸塞州急诊室在实现责任医疗组织目标方面仍然缺乏明确的指示和直接参与。
Study objective: We assess Massachusetts emergency department (ED) involvement and internal ED constructs within accountable care organization contracts.& para;& para;Methods: An online survey was distributed to 70 Massachusetts ED directors. Questions attempted to assess involvement of EDs in accountable care organizations and the structures in place in EDs-from departmental resources to physician incentives-to help achieve accountable care organization goals of decreasing spending and improving quality.& para;& para;Results: Of responding ED directors, 79% reported alignment between the ED and an accountable care organization. Almost all ED groups (88%) reported bearing no financial risk as a result of the accountable care organization contracts in which their organizations participated. Major obstacles to meeting accountable care organization objectives included care coordination challenges (62%) and lack of familiarity with accountable care organization goals (58%). The most common cost-reduction strategies included ED case management (85%) and information technology (61%). Limitations of this study include that information was self-reported by ED directors, a focus limited to Massachusetts, and a survey response rate of 47%.& para;& para;Conclusion: The ED directors perceived that the majority of physicians were not familiar with accountable care organization goals, many challenges remain in coordinating care for patients in the ED, and most EDs have no financial incentives tied to accountable care organizations. EDs in Massachusetts have begun to implement strategies aimed at reducing admissions, utilization, and overall cost, but these strategies are not widespread apart from case management, even in a state with heavy accountable care organization penetration. Our results suggest that Massachusetts EDs still lack clear directives and direct involvement in meeting accountable care organization goals.