Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria

飓风玛丽亚后波多黎各医生组织的初级保健转型

• 批准号: 10345390
• 负责人: Justin W. Timbie
• 金额: $ 77.58万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345390
• 关键词: Address; Advisory Committees; Alternative Health; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Caregivers; Caring; Cessation of life; Clinic; Collaborations; Complex; Contracts; Data; Disasters; Economics; Elderly; Eligibility Determination; Enrollment; Federal Government; Federally Qualified Health Center; Fee-for-Service Plans; Financial Support; Funding; Future; Geography; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hispanic Americans; Hospitals; Hurricane; Incentives; Infrastructure; Interview; Investments; Long-Term Care; Long-Term Effects; Low income; Managed Care; Measures; Medicaid; Medical; Medicare; Methods; Modeling; Organizational Models; Outcome; Patients; Performance; Physicians; Primary Care Physician; Primary Health Care; Protocols documentation; Provider; Puerto Rico; Quality of Care; Recording of previous events; Recovery; Research; Research Personnel; Resource-limited setting; Services; Shapes; Surgeon; System; United States Agency for Healthcare Research and Quality; Universities; Water; beneficiary; care coordination; care delivery; college; design; dual eligible; experience; food shortage; health care delivery; health care service; health care service organization; health disparity; health disparity populations; health plan; implementation barriers; improved; informal caregiver; interest; medical specialties; migration; older patient; patient advocacy group; payment; recruit; telehealth; trend

Project Summary/Abstract In September 2017, Hurricane Maria brought unprecedented devastation to Puerto Rico. The Hurricane’s impact was disproportionately borne by elderly patients and residents of remote areas of Puerto Rico who were vulnerable to disruptions in health care services. Providers and policymakers are currently seeking to make major investments in Puerto Rico’s primary care delivery system that were outlined in Puerto Rico’s recovery plan. However, the ability of Puerto Rico’s physician organizations (POs) to undertake large-scale primary care transformation remains unclear. In particular, POs might differ widely in both their existing primary care infrastructure as well as the level of technical or financial support they typically receive to implement new infrastructure from the health systems or independent physicians associations with which they are affiliated, from the Medicare Advantage plans and Medicaid managed care organizations with which they contract, or from the federal government. The proposed study, which builds on an existing collaboration between RAND and the University of Puerto Rico, will examine four models of physician organization in Puerto Rico: federally qualified health centers, small independent medical groups, large independent medical groups, and vertically- integrated medical groups. We will use Medicare fee-for-service claims and Medicare Advantage encounter data to assess trends in the physician workforce providing care through these four delivery models, the Medicare beneficiaries who receive care through each model, and changes in both trends following Hurricane Maria. We will then assess changes in access, quality of care, and care coordination before and after Hurricane Maria to measure differences in performance across PO models and to identify high-performing POs and low-performing POs in each model. We will conduct interviews with leaders of 32 of the highest-performing POs and lowest-performing POs in each model to identify the advanced primary care infrastructure they have sought to implement as well as implementation barriers. Finally, we will interview Medicare beneficiaries living with Alzheimer’s disease (or Alzheimer’s disease related dementias) and their caregivers to better understand their unmet care needs and how these needs differ across the four PO models. The research will be guided and supported by an Advisory Committee comprising representatives of two local provider associations and two local patient advocacy groups that represent older adults and people living with Alzheimer’s disease and Alzheimer’s disease related dementias. The study will help to identify specific models of physician organization that are associated with higher performance that could help guide Puerto Rico’s Hurricane Maria recovery effort. Our findings could also help stakeholders prioritize the expansion of specific services that could most directly improve the lives of patients with Alzheimer’s disease or Alzheimer’s disease related dementias and their caregivers and identify the types of POs that might need greater support to address current gaps.

项目摘要/摘要 2017年9月，飓风玛丽亚给波多黎各带来前所未有的破坏。飓风的 老年患者和波多黎各偏远地区的居民承担了不成比例的影响 容易受到卫生保健服务中断的影响。供应商和政策制定者目前正寻求使 在波多黎各复苏过程中概述的对波多黎各初级保健提供系统的主要投资 计划。然而，波多黎各的医生组织(POS)承担大规模初级保健的能力 转型仍不明朗。特别是，POS在其现有初级保健方面可能有很大不同 基础设施以及他们通常获得的技术或财务支持水平来实施新的 基础设施来自卫生系统或他们所属的独立医生协会， 来自与其签订合同的Medicare Advantage计划和Medicaid管理型医疗组织，或 来自联邦政府的。这项拟议的研究建立在兰德和兰德之间现有合作的基础上 和波多黎各大学，将审查波多黎各的四种医生组织模式：联邦 有条件的卫生院、小的独立医疗集团、大的独立医疗集团，以及垂直- 综合医疗集团。我们将使用Medicare按服务收费索赔和Medicare Advantage遭遇 为了评估通过这四种交付模式提供护理的医生队伍的趋势， 通过每种模式接受护理的医疗保险受益者，以及飓风后这两种趋势的变化 玛丽亚。然后，我们将评估前后在获取、护理质量和护理协调方面的变化 飓风玛丽亚将衡量各采购订单模型之间的性能差异，并确定高绩效采购订单 以及每款车型的低性能POS。我们将对32位表现最好的领导人进行采访 每个型号中的PoS和性能最差的PoS，以确定其拥有的高级初级保健基础设施 寻求实施以及实施障碍。最后，我们将采访生活在医疗保险中的受益人 与阿尔茨海默病(或阿尔茨海默病相关痴呆)及其照顾者更好地了解 他们未得到满足的护理需求，以及这些需求在四种PO模式中有何不同。这项研究将在 并由咨询委员会提供支持，咨询委员会由两个当地提供商协会的代表和 代表老年人和阿尔茨海默病患者的两个当地患者权益倡导组织 阿尔茨海默病相关痴呆症。这项研究将有助于确定医生组织的具体模式 与更高的表现相关，这可能有助于引导波多黎各飓风玛丽亚的恢复 努力。我们的发现还可以帮助利益相关者优先考虑最大限度地扩大特定服务 直接改善阿尔茨海默病或阿尔茨海默病相关痴呆患者的生活 他们的照顾者，并确定可能需要更多支持以弥补目前差距的POS类型。