Variation of hospital-based adoption of care coordination services by community-level social determinants of health
Variation of hospital-based adoption of care coordination services by community-level social determinants of health
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DOI：
10.1097/hmr.0000000000000232
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发表时间：
2020-10-01
影响因子：
2.5
通讯作者：
Wang, Min Qi
中科院分区：
文献类型：
--
作者：
Chen, Jie;DuGoff, Eva Hisako;Wang, Min Qi
背景 医院对护理协调服务和创新服务模式的投资是提高护理效率和人口健康的重要来源。目的 本研究的目的是在组织理论框架内探索医院发起的护理协调服务和参与责任护理组织 (ACO) 的变化。方法 我们的主要数据集包括 2015 年美国医院协会年度调查、护理系统和支付调查、美国社区调查和地区健康资源文件。两个主要成果是 (a) 医院报告的护理协调实践启动（例如慢性病管理、出院后护理连续性和预测分析）和 (b) 参与 ACO 模型。国家固定效应模型用于测试护理协调实践的采用与医院特征、社区层面的社会人口特征和卫生政策之间的关联。结果 床位较大、位于城市地区和/或手术量较大的医院更有可能采用护理协调实践并参与 ACO 模型。为无保险率和/或贫困率较高的社区提供服务的医院提供护理协调实践的可能性明显较小。更严格的社区福利法 (CBL) 与护理协调实践的实施呈正相关，表明 CBL 具有强大的规范影响。结论 在资源丰富的地区可以采用更多的医院发起的护理协调实践和创新的 ACO 模式。政策制定者可以考虑增加农村、服务欠缺和高贫困高无保险地区护理协调实践的资源，以确保弱势群体能够从这些服务中受益。
Background Hospital investments in care coordination services and innovative delivery models represent an important source for improving care efficiency and population health. Objective The aim of this study was to explore variation of hospital-initiated care coordination services and participation in Accountable Care Organizations (ACOs) by community characteristics within an organizational theory framework. Methods Our main data sets included the 2015 American Hospital Association Annual Survey, Survey of Care Systems and Payment, American Community Survey, and Area Health Resource File. Two main outcomes were (a) hospital-reported initiation of care coordination practices (such as chronic disease management, post-hospital discharge continuity of care, and predictive analytics) and (b) participation in ACO models. State fixed-effects models were used to test the association between the adoption of care coordination practices and hospital characteristics, community-level sociodemographic characteristics, and health policies. Results Hospitals with large bed size, located in urban areas, and/or with high volume of operations were more likely to adopt care coordination practices and participate in the ACO models. Hospitals serving communities with high uninsurance rates and/or poverty rates were significantly less likely to provide care coordination practices. More stringent Community Benefit Laws (CBLs) were positively associated with the implementation of care coordination practices suggesting strong normative impacts of CBLs. Conclusion Greater hospital-initiated care coordination practices and innovative ACO models were available in well-resourced areas. Policymakers may consider increasing resources for care coordination practices in rural, underserved, and high-poverty-high-uninsured areas to ensure that vulnerable populations can benefit from these services.