Rural Health Clinics in Accountable Care Organizations: Impact on Disparities

描述(申请人提供)：拟议的纵向研究调查乡村卫生诊所(RHC)为美国南部地区的老年人提供的护理，以及这种护理的成本。责任关怀组织(ACO)为RHC提供了潜在的机会，尽管农村对ACO的参与存在一些限制。然而，关于ACO模式如何适应农村社区卫生机构的独特挑战，以及农村社区卫生机构的参与对包括少数群体在内的农村老年人健康差距的影响，人们知之甚少。本研究的具体目的是：1)分析和描述农村社区卫生服务机构参与农村社区卫生服务的程度，以及选择参与社区卫生服务的社区卫生服务机构的特点；2)分析农村社区卫生服务机构参与社区卫生服务的情况及其他影响农村社区卫生服务人群健康差距的因素；3)分析社区卫生服务机构参与社区卫生服务及其他影响老年社区卫生服务成本效益和预防护理效果的因素。主要的研究假设是：1)与独立的RHC相比，基于提供者的RHC参与ACOs的比例更高；2)网络中的RHC将比非附属RHC更有可能参与ACOs；3)大型RHC比小型RHC更有可能参与ACOs；4)RHC参与ACOs与减少老年农村患者的差异正相关，控制了背景因素的影响；5)RHC参与ACOs与护理实践的质量正相关，控制了背景因素的影响 6)在控制相关因素(例如，民族/种族分布和农村)的影响后，农村老年患者的健康状况与RHC的参与呈正相关；7)RHC对ACOs的参与将对成本效益和预防保健效果产生积极影响。我们将使用定量和定性研究方法，包括二级数据分析、调查研究和案例研究，对我们的分析进行三角划分。将对一个由大约800个农村地区保健中心组成的小组七年来的组织和社区相关数据进行多变量分析，以便对影响农村地区卫生中心业绩和成果的因素提出更具普遍性的看法。 公共卫生相关性：农村卫生诊所面临着许多挑战，例如为慢性病发病率高于城市社区的社区提供服务，以及吸引和留住合格的专业人员。在分析RHC参与责任关怀组织如何影响其绩效的过程中，这项研究将帮助政策领导人做出决策，以加强美国农村的医疗保障网络。

DESCRIPTION (provided by applicant): The proposed longitudinal study investigates the care provided by Rural Health Clinics (RHCs) to older adults in the Southern region of the U.S., as well as the costs of that care. Accountable Care Organizations (ACOs) offer potential opportunities to RHCs despite several rural constraints to ACO participation. However, little is known about how the ACO model accommodates the unique challenges of RHCs, and the impact of RHC participation on the health disparities of rural older adults including those of minority groups. The specific aims of the study are: 1) to analyze and describe the extent of RHC participation in ACOs, and the characteristics of RHCs that choose to participate in ACOs; 2) to analyze ACO participation and other factors that impact health disparities of rural populations served by RHCs; and 3) to analyze ACO participation and other factors that impact cost efficiency and preventive care effectiveness for RHC older adult patients. The major research hypotheses are: 1) A higher percentage of provider-based RHCs will participate in ACOs compared to independent RHCs; 2) RHCs in networks will be more likely to participate in ACOs than unaffiliated RHCs; 3) Large RHCs are more likely to participate in ACOs than small RHCs; 4) RHC participation in ACOs is positively related to reduction of disparities of older adult rural patients, controlling for the effects of contextual factors; 5) RHC participation in ACOs is positively related to quality of care practices, controlling for the effects of contextual factors (such as ethnic/racial distribution and rurality); 6) RHC participation in ACOs is positively related to health outcomes of older adult rural patients, controlling for the effects o contextual factors (such as ethnic/racial distribution and rurality); and 7) RHC participation in ACOs will have a positive impact on cost efficiency and preventive care effectiveness. We will triangulate our analyses by using both quantitative and qualitative research methods including analysis of secondary data, survey research, and case studies. Multivariate analyses of seven years of organizational and community-related data of a panel of approximately 800 RHCs will be performed in order to develop more generalizable ideas about the factors contributing to RHC performance and outcomes. PUBLIC HEALTH RELEVANCE: Rural Health Clinics (RHCs) face numerous challenges such as serving communities with higher rates of chronic disease compared to urban communities, & attracting & retaining qualified professional staff. In analyzing how RHCs' participation in Accountable Care Organizations affects their performance, this study will assist policy leaders in making decisions that will strengthen the health care safety net in rural America.