PA-20-072, Measuring the Clinical and Economic Outcomes Associated with Delivery Systems: "Are Health Systems Better at Responding to Pandemics?"

其他项目信息-项目概要/摘要 PA-20-072：卫生系统是否更好地应对流行病？ 这个项目的目标是提供证据证明综合卫生系统是否会带来更好或更差的护理 在COVID-19疫情期间，独立供应商的结果。医疗保健经历了巨大的 近年来，随着供应商迅速组装成更大的系统，合并也越来越多。从业者和政策 制造商们就这种整合是好是坏展开了激烈的辩论， 只有一点经验证据 我们将研究综合护理在一个至关重要的背景下的影响-应对COVID-19 疫情在流行病期间，综合护理系统具有一些优势：它们可能具有财政上的优势， 资源，以更好地抵御负面的收入冲击，更多的物理空间，以分开COVID-19和非 COVID-19患者，以及更好的信息技术基础设施，以允许大规模的远程医疗。然而，在这方面， 综合系统可能过于集中于急性病人，以至于无法跟上基于社区的 需要的人口。大型综合系统也可能与每个患者的需求联系较少。 我们提出的分析有三个组成部分。首先，我们将研究如何不同的药物治疗的病人 在COVID-19危机期间，在综合卫生系统内外。治疗措施将包括检测 对于COVID-19以及COVID-19的医疗护理接收：与医疗保健提供者的访问（无论是亲自 和远程医疗），并为社区中的人提供长期治疗。第二，我们将研究 系统内外患者的健康结果和护理体验如何不同。某个结果 措施适用于许多患者群体，包括死亡、严重疾病住院治疗， 患者对所接受护理质量的评估。其他结果是特定于某些亚组，包括 癌症患者的肿瘤进展，妊娠患者分娩部位的变化，以及生存能力 为有身体和精神障碍的成人和儿童独立提供服务。第三，我们将研究 由于COVID-19，护理组织正在发生变化。为了理解这一点，我们将跟踪实践关闭 沿着的是随着COVID-19疫情的发展，较小的供应商合并成较大的系统。 我们的患者分析将使用几个数据来源，包括医疗保险索赔，商业索赔记录， 有保险的个人，以及在大州分娩的人。为了跟踪关闭，我们将使用Medicare付款 沿着私营部门关于保健整合的数据。

OTHER PROJECT INFORMATION – Project Summary/Abstract PA-20-072: Are Health Systems Better at Responding to Pandemics? The goal of this project is to provide evidence on whether integrated health systems lead to better or worse care outcomes than independent providers during the COVID-19 epidemic. Health care has undergone enormous consolidation in recent years, as providers have rapidly assembled into bigger systems. Practitioners and policy makers have engaged in spirited debate about whether such consolidation is good or bad, but there has been only a little empirical evidence on the topic. We will study the impact of integrated care in a crucially important setting – the response to the COVID-19 epidemic. Integrated systems of care have some advantages during an epidemic: they may have the financial resources to better withstand negative revenue shocks, more physical space to separate COVID-19 and non- COVID-19 patients, and better information technology infrastructure to permit widescale telemedicine. However, integrated systems may be so focused on acute patients that they fail to keep up with the community-based population in need. Large integrated systems may also be less in touch with the needs of each individual patient. Our proposed analysis has three components. First, we will examine how medical treatments differ for patients in and outside of integrated health systems during the COVID-19 crisis. Measures of treatment will include testing for COVID-19 as well as medical care receipt apart of COVID-19: visits with health care providers (both in-person and telemedicine), and maintenance of chronic therapy for those in the community. Second, we will examine how health outcomes and the experience of care differ for patients in and outside of systems. Some outcome measures are appropriate for many groups of patients, including death, hospitalization with severe disease, and patient assessments of the quality of care received. Other outcomes are specific to certain subgroups, including tumor progression for patients with cancer, changes in site of delivery for pregnant patients, and ability to live independently for adults and children with physical and mental impairments. Third, we will examine how the organization of care is changing as a result of COVID-19. To understand this, we will track practice closures along with mergers of smaller providers into larger systems as the COVID-19 epidemic proceeds. Our patient analysis will use several sources of data, including Medicare claims, claims records for commercially insured individuals, and people giving birth in a large state. To track closures, we will use Medicare payment data along with private sector data on health care consolidation.