Effecting Change in Chronic Care: The Tipping Point

影响慢性病护理的变革：转折点

• 批准号: 6800845
• 负责人: Karen Kmetik
• 金额: $ 36.39万
• 依托单位: AMERICAN MEDICAL ASSOCIATION
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2006-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6800845
• 关键词: behavioral /social science research tag; chronic disease /disorder; clinical research; cooperative study; health care quality; health care service evaluation; health care service planning; health service demonstration project; health services research tag; human data; information dissemination; patient oriented research

Chronic conditions have become the leading cause of illness, disability, and death in the United States, affect almost half of the U.S. population, and account for the majority of health care expenditures in this country. Despite efforts to enhance the quality of care delivered to chronically ill patients, studies continue to reveal tremendous variability in both practice and outcomes in this population. This study proposes to bring together a unique collaboration of physicians, employers, health plans, and payers from the private and public sector both regionally and nationally, to achieve a 'tipping point' in health care and, thereby, accelerate the rate at which improvement in the quality of care delivered in outpatients settings for a substantial portion of the chronically itt patient population in the U.S can occur. Specifically, the American Medical Association, Pittsburgh Regional Healthcare Initiative, Iowa Foundation for Medical Care, Blue Cross and Blue Shield Association, Centers for Medicare and Medicaid Services, and the Midwest Business Group on Health are cooperating in a partnership to identify the infrastructure necessary to make relevant data and clinical performance measurement tools available to physicians at the point of care for patients with diabetes, major depressive disorder, or coronary artery disease; to enable data collection, retrieval, and transfer within and across physician offices, health plans, and laboratories; to identify the perceived obstacles, burdens, as well as incentives for physicians and others who participate in efforts to improve the quality of care for patients with chronic diseases through the use of performance measurement; and to determine the feasibility of creating an integrated data registry that will enable the provision of benchmarking data to physicians and aggregate data to health plans and third party payors. The methods by which these aims will be achieved inctude adaptation and implementation of performance measurement sets developed by the Physician Consortium for Performance improvement for diabetes, major depressive disorder, and coronary artery disease in a select sample of primary care physician offices in two regions of the U.S.; on-site identification of data capabilities for physicians, health plans, and laboratories participating in the study; and evaluation of physician, plan, laboratory, and employer experience with measurement tools and data collection and delivery processes.

慢性病已成为美国疾病、残疾和死亡的主要原因，影响到近一半的美国人口，并占美国医疗保健支出的大部分。尽管努力提高向慢性病患者提供的护理质量，但研究继续显示，在这一人群中，实践和结果都存在巨大差异。这项研究建议将来自地区和全国的私人和公共部门的医生、雇主、健康计划和支付者的独特合作聚集在一起，以实现医疗保健的“临界点”，从而加快美国相当大一部分长期ITT患者的门诊服务质量改善的速度。具体地说，美国医学会、匹兹堡地区医疗保健倡议、爱荷华州医疗保健基金会、蓝十字和蓝盾协会、医疗保险和医疗补助服务中心以及中西部健康业务小组正在合作确定必要的基础设施，以便在治疗糖尿病、严重抑郁障碍或冠状动脉疾病的患者时向医生提供相关数据和临床表现测量工具；使数据能够在医生办公室、健康计划和实验室内和之间进行收集、检索和传输；确定医生和其他参与通过使用绩效衡量改善慢性病患者护理质量的努力的障碍、负担以及激励措施；并确定创建一个综合数据登记处的可行性，该数据登记处将能够向医生提供基准数据，并将数据汇总到健康计划和第三方付款人。实现这些目标的方法包括：在美国两个地区选定的初级保健医生办公室样本中，广泛调整和实施医生联盟为改善糖尿病、严重抑郁障碍和冠状动脉疾病的绩效而开发的绩效衡量集；现场确定参与研究的医生、健康计划和实验室的数据能力；以及评估医生、计划、实验室和雇主在测量工具和数据收集和交付过程中的经验。