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MANAGED CARE AND COMMUNITY HEALTH CENTERS

管理式医疗和社区健康中心

基本信息

批准号：
2871181
负责人：
LEIYU SHI
金额：
$ 8.1万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1998
资助国家：
美国
起止时间：
1998-09-30 至 2001-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2871181
关键词：
behavioral /social science research tag community health services data collection methodology /evaluation health care service evaluation health services research tag human data managed care outcomes research social service evaluation statistics /biometry

项目摘要

The two objectives of the project are to assess the determinants of Community Health Centers' involvement in managed care and the impact of managed care on Community Health Centers (CHCs). Such knowledge is critical for the continued success of CHCs' in carrying out their mission to serve the nation's underserved and vulnerable populations. The project employs secondary analysis of an administrative, longitudinal database, the Uniform Data System (UDS) and its predecessor the Bureau Common Reporting Requirements (BCRR) maintained by the Bureau of Primary Health Care (BPHC). We will use 1991-1997 data for this project including 1991-1995 BCRR and 1996-1997 UDS. There are approximately 600 BPHC-funded CHCs in each year. The BCRR and UDS datasets will be linked via a common field: grantee's unique BCRR or UDS number. A series of multivariate analyses, including logistic regressions, multiple regressions, Tobit models, and a multinomial logistic regression model, will be performed to assess both external environmental and internal organizational determinants of CHCs' involvement in managed care. External factors include state Section 1115 waiver status, percent of revenue from grant funding, percent of revenue from Medicaid, and rural/urban location. Internal factors include center size and Medicaid patients as a proportion of total users. Rates of change in percent of revenue from grant funding, Medicaid, and changes in proportion of Medicaid patients are included in the analyses to capture the impact of trend. The generalized estimating equation (GEE) methods for longitudinal data will be used as the main tools for the data analyses. Both bivariate and multivariate analyses will be conducted to examine the impact of managed care on CHC outcomes. In the bivariate analyses, ANOVA and Post-hoc means tests will be performed for each year to a assess the relation between level of managed care involvement and CHC outcomes. In multivariate analyses, pooled cross-sectional longitudinal analyses ("growth models") will be used to examine the impact of managed care status on pattern-changes of CHC outcome measures over time. CHC outcome variables include the proportion of uninsured patients, vulnerable patients, proportion of expenses used for enabling services, and financial stability, efficiency, and productivity measures.

该项目的两个目标是评估以下决定因素社区卫生中心在管理型医疗中的参与及其影响社区卫生中心(CHCs)的管理式护理。这样的知识是对于社区卫生服务中心继续成功地执行其服务于国家服务不足和弱势群体的使命。该项目采用了二次分析，纵向数据库、统一数据系统(UDS)及其前身局维持的局共同报告要求(BCRR) 初级卫生保健(BPHC)。为此，我们将使用1991-1997年的数据项目包括1991-1995年BCRR和1996-1997年UDS。确实有每年大约有600家由BPHC资助的儿童健康中心。BCRR和UDS 数据集将通过一个公共字段链接：被授权者的唯一BCRR或UDS 数。一系列的多变量分析，包括逻辑回归，多元回归、托比特模型和多项逻辑分析回归模型，将两者进行外部评估社区卫生中心的环境和内部组织决定因素参与管理型医疗保健。外部因素包括州政府部门 1115豁免状态，赠款资金收入的百分比，百分比来自医疗补助和城乡地点的收入。内部因素包括中心规模和医疗补助患者占总数的比例用户。赠款资金收入百分比的变动率，医疗补助，以及医疗补助患者比例的变化在分析中捕捉趋势的影响。泛化的将使用纵向数据的估计方程(GEE)方法作为数据分析的主要工具。将进行双变量和多变量分析来检验管理性医疗对CHC结局的影响。在双变量分析中，每年将进行ANOVA和POST-HOC经济状况调查评估管理性护理参与程度与CHC之间的关系结果。在多变量分析中，合并横截面纵向分析(“增长模型”)将被用来检验托管的模式上的关怀状态--CHC结果测量随时间的变化。CHC 结果变量包括未参保患者的比例，弱势患者，用于使能服务的费用比例，以及金融稳定性、效率和生产率指标。