Comparative Effectiveness of Virginia Coordinated Care versus the Traditional Saf

弗吉尼亚协调护理与传统 SAF 的效果比较

• 批准号: 8055657
• 负责人: Wally R Smith
• 金额: $ 125.39万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 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/8055657
• 关键词: Comparative; Effectiveness; Virginia; Coordinated; Care

DESCRIPTION (provided by applicant): The primary Aim of this study is to compare the effectiveness of the VCC, particularly the primary care component, with that of a traditional safety net delivery system at reducing the frequency of emergency department utilization, hospital utilization, and adverse health outcomes among uninsured patients who used the Virginia Commonwealth University Health System (VCUHS) from January 2003- December 2009, with attention to understanding the conditions and the types of patients for which the program was most effective. This will be achieved by a retrospective cohort study featuring three comparative analyses by cohorts: (1) comparison of utilization and adverse outcomes for VCC enrolees in the year after enrolment, versus the same patients during year prior to enrollment; (2) comparison of utilization and adverse outcomes for VCC enrolees versus simultaneous utilization and health outcomes of a similar uninsured population not enrolled in VCC, specifically patients classified as indigent and uninsured on VCUHS claims; (3) comparisons of utilization and adverse outcomes for VCC enrollees by the degree they engaged their assigned primary care provider. Analyses will be controlled for demographic characteristics and comorbidity. In addition, we will perform comparisons between PCMHs (group practices) within the VCC when the number of empanelled patients is large enough to permit statistically valid comparisons. Last, a secondary hypothesis will be explored by conducting separate analyses for patients with three of the MMedicare Modernization Act 14 priority conditions identified by AHRQ (pursuant to Section 1013 of the Medicare Prescription Drug Improvement and Modernization Act of 2003): cardiovascular disease, diabetes, and pulmonary disease/asthma. We chose these three conditions because each may require ED utilization, hospital or intensive care unit utilization, intubation, or result in death. The Secondary Aim of the study is to identify the successful and replicable elements of primary care case management, care coordination, and other attributes of the patient-centered primary care model that make the VCC program effective, with attention to understanding how and why these elements are critical for different patient populations. This will be achieved by qualitative analyses, consisting of key informant interviews and focus groups with four stakeholder groups: program executives/leadership, provider physicians, care coordinators, and patients, informed by results from previous work and from analyses performed under the first Aim. In addition, we will perform comparisons between practices providing PCMHs within the VCC when the number of empanelled patients is large enough to permit statistically valid comparisons. PUBLIC HEALTH RELEVANCE: The primary Aim of this study is to compare the effectiveness of the VCC, particularly the primary care component, with that of a traditional safety net delivery system at reducing the frequency of emergency department utilization, hospital utilization, and adverse health outcomes among uninsured patients who used the Virginia Commonwealth University Health System (VCUHS) from January 2003- December 2009. Attention will be paid to understanding the conditions and the types of patients for which the program was most effective. The Secondary Aim of the study is to identify the successful and replicable elements of primary care case management, care coordination, and other attributes of the patient-centered primary care model that make the VCC program effective. Attention will be paid to understanding how and why these elements are critical for different patient populations. This will be achieved by qualitative analyses, consisting of key informant interviews and focus groups with four stakeholder groups: program executives/leadership, provider physicians, care coordinators, and patients, informed by results from previous work and from analyses performed under the first Aim.

描述（由申请人提供）：本研究的主要目的是比较 VCC（特别是初级保健部分）与传统安全网提供系统的有效性，以减少 2003 年 1 月至 2009 年 12 月期间使用弗吉尼亚联邦大学医疗系统 (VCUHS) 的未参保患者的急诊室使用频率、医院使用率和不良健康结果，并注意了解该计划最有效的患者的病情和类型。这将通过一项回顾性队列研究来实现，该研究包括三项队列比较分析：(1) 入组后一年内 VCC 参与者与入组前一年内相同患者的利用率和不良结果的比较； (2) VCC 参保者的利用率和不良结果与未加入 VCC 的类似未参保人群（特别是在 VCUHS 索赔中被分类为贫困和未参保的患者）的同时利用率和健康结果进行比较； (3) 根据 VCC 参与者参与指定初级保健提供者的程度来比较其利用率和不良后果。将控制人口特征和合并症的分析。此外，当入组患者数量足够大以进行统计上有效的比较时，我们将在 VCC 内的 PCMH（团体实践）之间进行比较。最后，将通过对患有 AHRQ 确定的 MMedicare 现代化法案 14 优先条件中的三种（根据 2003 年 Medicare 处方药改进和现代化法案第 1013 条）的患者进行单独分析来探讨次要假设：心血管疾病、糖尿病和肺部疾病/哮喘。我们选择这三种情况是因为每种情况都可能需要急诊室、医院或重症监护室、插管或导致死亡。 该研究的次要目标是确定初级保健病例管理、护理协调以及以患者为中心的初级保健模式的其他属性的成功和可复制要素，使 VCC 计划有效，并注意了解这些要素如何以及为何对不同患者群体至关重要。这将通过定性分析来实现，包括关键知情人访谈和焦点小组，其中包括四个利益相关者群体：项目主管/领导层、提供者医生、护理协调员和患者，并根据之前的工作结果和第一个目标进行的分析提供信息。此外，当入组患者数量足够大以允许进行统计上有效的比较时，我们将对 VCC 内提供 PCMH 的实践进行比较。 公共健康相关性：本研究的主要目的是比较 VCC（特别是初级保健部分）与传统安全网提供系统的有效性，以减少 2003 年 1 月至 2009 年 12 月期间使用弗吉尼亚联邦大学医疗系统 (VCUHS) 的未参保患者的急诊室使用频率、医院使用率和不良健康结果。将注意了解该计划最有效的患者的病情和类型。该研究的次要目标是确定初级保健病例管理、护理协调以及以患者为中心的初级保健模式的其他属性的成功和可复制要素，这些要素使 VCC 计划有效。我们将重点关注了解这些要素如何以及为何对不同患者群体至关重要。这将通过定性分析来实现，包括关键知情人访谈和焦点小组，其中包括四个利益相关者群体：项目主管/领导层、提供者医生、护理协调员和患者，并根据之前的工作结果和第一个目标进行的分析提供信息。