Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.
Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.
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DOI：
10.1097/mlr.0000000000000477
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发表时间：
2016-03
期刊：
影响因子：
3
通讯作者：
Colla CH
中科院分区：
文献类型：
--
作者：
Albright BB;Lewis VA;Ross JS;Colla CH
责任医疗组织（ACO）是一种交付和支付模式，旨在协调医疗，控制成本和提高质量。Medicare ACO负责八项预防性护理质量措施。创建预防保健质量的复合措施，并检查ACO特征与性能的关联。医疗保险共享储蓄计划和先锋参与者的横断面研究。我们将质量绩效与来自全国ACO调查的描述性数据联系起来。我们使用探索性因素分析创建了复合指标，并使用回归来评估与组织特征的关联。在252名合格的ACO中，246名报告了预防保健质量，其中177名完成了调查（应答率=72%）。在第一年，ACO在大多数可比指标上落后于PPO。我们在八项措施中确定了两个基本因素，并为每项措施创建了复合材料：由疫苗和癌症筛查驱动的疾病预防，以及由年度健康筛查驱动的健康筛查。参与高级支付模式，拥有更少的专家，每个初级保健提供者拥有更多的医疗保险ACO受益人，这两个复合材料的性能显着提高。疾病预防方面的更好表现也与医院的纳入、更大的电子健康记录能力、更大的初级保健工作人员队伍和更少的少数族裔受益人有关。ACO预防性护理质量绩效与提供者构成有关，并受益于前期投资。疫苗和癌症筛查的质量表现更依赖于组织结构和特征，而不是年度健康筛查的表现，这可能是由于资格确定和服务管理的复杂性更大。
Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.