Understanding Frequent EMS Users in the D.C. Health Care System: Evidence from Medicaid Claims Data

项目摘要 紧急医疗服务(EMS)的频繁用户，或EMS的超级用户，给当地的EMS带来了负担 系统和更广泛的医疗保健系统，通过促进急诊科(ED)过度拥挤和 医院使用效率低下。由于现有国家级数据来源的限制和高水平的 在地方和州一级的EMS系统中，EMS的使用是一个未被充分研究的健康领域 服务文献。目前的知识是有限的，在急诊室和住院患者利用的背景下被理解。 应用行为生态学框架，这项创新的多方法研究试图提供一种改进的 了解频繁使用EMS与更广泛的医疗保健系统之间的关系。在此过程中， 研究小组希望确定可能的特定背景因素，这些因素可能导致EMS频率的减少 使用，更适当地使用卫生保健资源，并降低成本。中心假设是存在 医疗保健资源使用、成本和门诊网络连接方面的显著差异与特定的 EMS超级用户群体的特征和EMS频繁使用的纵向模式。这项研究将 使用哥伦比亚特区(DC)6年内(2014-19财年)的医疗补助索赔数据，这是 选择它是因为它的人均EMS呼叫量较高，未投保率较低。个人特点、医疗保健 成年EMS用户的使用率和医疗补助成本将通过对已确定的 索赔数据(目标1和2)。我们将使用网络分析来探索门诊提供商的网络连接 适用于索赔衍生的共享患者提供者网络的方法(目标3)。这项研究尤其是 及时，因为《平价医疗法案》鼓励对创新支付和服务交付进行测试 模式，如移动集成健康-社区辅助医疗、替代目的地计划和 在全国范围内不同的EMS机构进行合作。预计研究结果将提供可操作的、背景- 具体的见解，可以指导医疗补助推动的努力，以提高城市EMS超级用户的护理效率 设置。此外，这项研究将提供一个有用的例子，说明不同的方法如何应用于行政管理 索赔数据可以被用来促进人口健康。这项研究建立在PI的方法培训的基础上， 在弱势群体护理协调方面的研究和专业经验，是一个协作性的 华盛顿的医疗补助机构和消防/EMS部门之间的努力。在研究团队的专业知识的支持下 在卫生经济学、卫生服务研究、计量经济学、网络分析以及 与EMS、医院、门诊医疗保健系统和社区合作伙伴合作，拟议的研究将 帮助推动PI的职业目标，即作为一项独立的卫生服务弥合研究与实践之间的鸿沟 研究员。

PROJECT ABSTRACT Frequent users of emergency medical services (EMS), or EMS “super-users”, present a burden to local EMS systems and the broader health care system by contributing to emergency department (ED) overcrowding and inefficient hospital use. Due to limitations in existing national-level data sources and the high level of heterogeneity in local- and state-level EMS systems, EMS use is an under-researched area of the health services literature. Current knowledge is limited and understood in the context of ED and inpatient utilization. Applying a behavioral-ecological framework, this innovative multi-methods study seeks to provide an improved understanding of the relationship between frequent EMS use and the broader health care system. In doing so, the study team hopes to identify possible context-specific factors that could lead to reductions in frequent EMS use, more appropriate use of health care resources, and lower costs. The central hypothesis is that there is substantial variation in health care resource use, costs, and outpatient network connectivity relating to specific characteristics of the EMS super-user population and longitudinal patterns of frequent EMS use. The study will use Medicaid claims data over a 6-year period (FY2014-19) from the District of Columbia (DC), which is chosen for its high per-capita EMS call volume and low uninsured rate. Individual characteristics, health care utilization, and Medicaid costs for adult EMS users will be assessed using regression analyses of de-identified claims data (Aims 1 and 2). Outpatient provider network connectivity will be explored using a network analysis approach applied to claims-derived shared-patient provider networks (Aim 3). This research is especially timely, since the Affordable Care Act has encouraged the testing of innovative payment and service-delivery models, such as Mobile Integrated Health-Community Paramedicine, alternative destination programs, and collaborations at various EMS agencies nationwide. Study findings are expected to provide actionable, context- specific insights that can guide Medicaid-driven efforts to improve care efficiency for EMS super-users in urban settings. Further, the study will provide a useful example of how disparate methods applied to administrative claims data can be leveraged to promote population health. The study builds on the PI's methods training, research, and professional experience in care coordination for vulnerable populations, and is a collaborative effort between DC’s Medicaid agency and Fire/EMS Department. Supported by the research team’s expertise in health economics, health services research, econometrics, network analysis, as well as experience in working with EMS, hospital, outpatient health care systems, and community partners, the proposed study will help advance the PI's career goal of bridging the research-practice divide as an independent health services researcher.