The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study.
The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study.
复制标题
董事会组成与医疗保险共享储蓄计划责任护理组织成果之间的关系：一项观察性研究。
DOI：
10.1007/s11606-021-07053-4
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发表时间：
2022
影响因子：
5.7
通讯作者：
Lagu,Tara
中科院分区：
文献类型：
--
作者：
Reimold,KimberlyE;Faridi,MohammadKamal;Pekow,PenelopeS;Erban,Joshua;Flannelly,Colin;Luikart,Ysabella;Lindenauer,PeterK;DeJong,Christene;D'Aunno,Tom;Lagu,Tara
背景医疗保险共享储蓄计划（MSSP）责任护理组织（ACO）的早期研究表明，医生领导是ACO成功的重要驱动力，但目前MSSP ACO管理委员会的人口统计学和专业组成与ACO公开报道的结果是否相关尚不清楚。目的调查医生参与程度较高和女性参与程度较高的管理委员会是否具有更好的效果。结果。设计横断面观察性研究。研究人员由医疗保险和医疗补助服务中心ACO公共使用文件（PUF）确定的所有2017年MSSP ACO。主要测量我们在2019年从ACO网站收集了管理委员会的组成。结果指标包括风险标准化再入院率和计划外入院率。我们使用描述性统计和线性回归模型来研究董事会组成与结果之间的关联。关键结果在2019年仍然存在并有可用数据的339个ACO中，77%的董事会中医生占多数，11.5%的董事会中没有女性。89%的人报告说，他们的董事会中有一名医疗保险受益人，其中约三分之一有一名女性代表。MSSP ACO董事会的平均成员人数为12人，平均67%为医生，24%为妇女。董事会的组成因ACO的特点而略有不同，如地理区域、受益人人数或参与者类型。对于心力衰竭患者（p=-0.26，p < 0.001）和患有多种慢性疾病的患者（p =-0.28，p = 0.001），ACO管理委员会中医生参与程度较高与全因非计划入院率较低相关。董事会中的妇女人数与任何结果differentiation.ConclusionsMSSP ACO理事会主要是男性和医生领导。医生的参与对于实现质量目标可能很重要，而缺乏女性参与则显示了董事会多元化的机会。
BackgroundEarly studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs’ publicly reported outcomes.ObjectiveTo investigate whether governing boards with higher physician participation and greater female involvement have better outcomes.DesignCross-sectional observational study.ParticipantsAll 2017 MSSP ACOs identified by the Center for Medicare and Medicaid Services ACO Public Use Files (PUF).Main MeasuresWe collected governing board composition from ACO websites in 2019. Outcome metrics included risk-standardized readmission and unplanned admissions rates. We used descriptive statistics and linear regression models to examine the association between board composition and outcomes.Key ResultsOf the 339 ACOs that still existed in 2019 and had available data, 77% had physician-majority boards and 11.5% had no women on their boards. Eighty-nine percent reported a Medicare beneficiary on their board, of which about one-third had a woman representative. The average number of members on MSSP ACO boards was 12, with a mean of 67% physicians and 24% women. Board composition varied minimally by ACO characteristics, such as geographic region, number of beneficiaries, or type of participants. Higher levels of physician participation in ACO governing boards were associated with lower all-cause unplanned admission rates for patients with heart failure (p= − 0.26,p< 0.001) and for patients with multiple chronic conditions (p= − 0.28,p= 0.001). The number of women on the board was not associated with any outcome differences.ConclusionsMSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.