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A Comparison of Provider Versus Health Plan Delivered Care Management in Michigan

密歇根州提供者与健康计划提供的护理管理的比较

基本信息

批准号：
8060298
负责人：
JODI Summers HOLTROP
金额：
$ 185.9万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2013-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8060298
关键词：
Comparison Provider Versus Health Plan

项目摘要

DESCRIPTION (provided by applicant): Over 1 billion dollars is spent annually for contracted companies to deliver disease management programs to adults with chronic conditions, yet evidence of the effectiveness and cost savings of these programs is lacking. Published research suggests that the more disease management is integrated into a patient's primary health care setting, the more effective it is in improving patient outcomes and saving health care dollars. A head-to- head comparison of these approaches - disease management/health insurance company (i.e. vendor) based versus primary care practice (i.e. provider) based disease management - has not been studied. We have a special opportunity to study a demonstration project that seeks to do just that. Blue Cross Blue Shield of Michigan (BCBSM), in partnership with 45 practices from five selected physician organizations (POs), will begin a demonstration project to test provider-delivered chronic disease care management (PDCM). At the same time, BCBSM will continue to deliver their health plan-based (i.e. vendor based) program (HPDCM) for their members in practices not in the demonstration project. We take advantage of this natural experiment in community primary care settings to conduct a comparative effectiveness study of these two care management approaches for adult patients with one and more of five chronic conditions: asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, or diabetes. Using qualitative, quantitative and mixed methods, we will observe, measure and describe the implementation of PDCM in the intervention practices. Using the lens of the Normalization Process Model, we will examine the implementation processes, environments, and the degree of care management integration to identify best practices for PDCM. Finally, we will compare patient outcomes to determine the relative effectiveness of each model of care delivery. The study aims are to: 1) extensively describe the implementation of PDCM in the practices of selected POs (intervention) including the barriers, facilitators, models and features, methods used, and costs to accomplish implementation; 2) compare the following patient-specific outcomes between patients offered PDCM versus HPDCM: a) engagement rates in care management, b) relevant clinical indicators, and c) health care utilization; and 3) describe the practice environments and contexts in which BCBSM chronic disease patients receive their care and to identify care management implementation and practice features associated with improved patient engagement and patient-specific outcomes. Research is needed to determine which choice is the best to make with our finite health care dollars: care management delivered by practices and their care teams (PDCM) or care management delivered by health insurers or companies disconnected from practice (vendor based or HPDCM). This study will provide a direct comparison of these two approaches and utilize innovative methods to discover new insights regarding best practices for PDCM within context. Without such studies, comparative effectiveness research will likely have little impact on translating research into practice. PUBLIC HEALTH RELEVANCE: Nearly one out of every two American adults has at least one chronic illness. Research has shown that care management services can improve chronic disease patient outcomes; however, it is unclear which health care entity is best positioned to provide the most cost-effective patient benefits. This study will compare provider- delivered care management (PDCM) to health plan-delivered care management (HPDCM); seeking to determine the comparative effectiveness of these two approaches on patient participation in care management, clinically relevant health indicators, and healthcare utilization.

描述（由申请人提供）：签约公司每年花费超过10亿美元向患有慢性病的成年人提供疾病管理计划，但缺乏这些计划的有效性和成本节约的证据。已发表的研究表明，将疾病管理纳入患者的初级卫生保健环境越多，在改善患者预后和节省卫生保健费用方面就越有效。这些方法的头对头比较-基于疾病管理/健康保险公司（即供应商）与基于初级保健实践（即提供者）的疾病管理-尚未进行研究。我们有一个特殊的机会来研究一个旨在做到这一点的示范项目。密歇根州蓝十字蓝盾（BCBSM）与来自五个选定的医生组织（PO）的45个实践合作，将开始一个示范项目，以测试提供者提供的慢性病护理管理（PDCM）。与此同时，BCBSM将继续在实践中为其成员提供基于健康计划（即基于供应商）的计划（HPDCM），而不是在示范项目中。我们利用这个自然的实验，在社区初级保健设置进行比较有效性研究这两种护理管理方法的成人患者与一个或多个五种慢性疾病：哮喘，慢性阻塞性肺疾病，充血性心力衰竭，冠状动脉疾病，或糖尿病。采用定性、定量和混合方法，观察、测量和描述PDCM在干预实践中的实施情况。使用规范化过程模型的透镜，我们将检查实施过程，环境和护理管理整合的程度，以确定PDCM的最佳实践。最后，我们将比较患者的结果，以确定每种护理模式的相对有效性。研究的目的是：1）广泛描述PDCM在选定参与组织的实践中的实施情况（干预）包括障碍、促进者、模型和特征、使用的方法以及完成实施的成本; 2）比较提供PDCM与HPDCM的患者之间的以下患者特异性结果：a）护理管理中的参与率，B）相关临床指标，以及c）卫生保健利用;以及3）描述BCBSM慢性病患者接受护理的实践环境和背景，并确定与改善患者参与度和患者特定结局相关的护理管理实施和实践特征。需要研究来确定哪种选择是最好的，我们有限的医疗保健美元：由实践及其护理团队（PDCM）或医疗保险公司或与实践脱节的公司（基于供应商或HPDCM）提供的护理管理。本研究将提供这两种方法的直接比较，并利用创新的方法来发现新的见解PDCM的最佳实践背景下。如果没有这些研究，比较有效性研究可能对将研究转化为实践的影响不大。公共卫生相关性：几乎每两个美国成年人中就有一个至少患有一种慢性疾病。研究表明，护理管理服务可以改善慢性病患者的预后;然而，目前还不清楚哪个医疗保健实体最适合提供最具成本效益的患者福利。本研究将比较提供者提供的护理管理（PDCM）和健康计划提供的护理管理（HPDCM）;试图确定这两种方法在患者参与护理管理、临床相关健康指标和医疗保健利用方面的比较有效性。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes.

健康计划和提供者提供的慢性病护理管理模式对患者临床结果的比较。

DOI：
10.1007/s11606-016-3617-2
发表时间：
2016
期刊：
Journal of general internal medicine
影响因子：
5.7
作者：
Luo,Zhehui;Chen,Qiaoling;Annis,AnnM;Piatt,Gretchen;Green,LeeA;Tao,Min;Holtrop,JodiSummers
通讯作者：
Holtrop,JodiSummers

Effect of care management program structure on implementation: a normalization process theory analysis.