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-项目摘要/摘要 PA-20-072：卫生系统是否能更好地应对流行病？ 该项目的目标是提供证据，说明综合卫生系统是否会带来更好或更差的医疗保健。 在新冠肺炎疫情期间，这一结果比独立的提供者更重要。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，出现了整合。从业者和政策 制造商就这种整合是好是坏展开了激烈的辩论，但也出现了 关于这个话题，只有很少的经验证据。 我们将在一个至关重要的背景下研究综合护理的影响--对新冠肺炎的回应 流行病。在疫情期间，综合护理系统有一些优势：它们可能有资金 资源以更好地抵御负面收入冲击，更多的物理空间来区分新冠肺炎和非 新冠肺炎患者，以及更好的信息技术基础设施，使大规模远程医疗成为可能。然而， 集成系统可能过于专注于急性患者，以至于它们无法跟上以社区为基础的 有需要的人口。大型集成系统也可能不太符合每个患者的需求。 我们建议的分析有三个组成部分。首先，我们将研究对患者的医疗治疗有何不同 在新冠肺炎危机期间，综合卫生系统内部和外部。治疗措施将包括检测 对于新冠肺炎以及除新冠肺炎之外的医疗收据：访问医疗保健提供者(均为面对面 和远程医疗)，以及为社区中的那些人维持慢性治疗。第二，我们将审查 系统内和系统外患者的健康结果和护理体验有何不同。一些结果 措施适用于许多群体的患者，包括死亡、严重疾病住院和 患者对所接受护理质量的评估。其他结果是某些分组特有的，包括 癌症患者的肿瘤进展、孕妇分娩部位的变化和生活能力 独立适用于有身体和精神障碍的成年人和儿童。第三，我们将研究如何 新冠肺炎正在改变护理的组织方式。为了理解这一点，我们将跟踪练习结束 随着新冠肺炎疫情的蔓延，规模较小的供应商合并成更大的系统。 我们的患者分析将使用几个数据来源，包括联邦医疗保险索赔、商业索赔记录 参保的个人，以及在大州生育的人。为了跟踪关闭，我们将使用Medicare Payment 数据以及私营部门关于医疗保健整合的数据。

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.