Impact of New Technologies on Chronic Heart Failure Outcomes and Costs in the VHA

新技术对 VHA 慢性心力衰竭结果和成本的影响

• 批准号: 8084752
• 负责人: PETER W. GROENEVELD
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8084752
• 关键词: Adrenergic beta-Antagonists; Affect; American; American Heart Association; Angiotensin-Converting Enzyme Inhibitors; Benchmarking; Cardiac; Cardiology; Caring; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Trials; Cost of Illness; Costs and Benefits; Data; Data Set; Data Sources; Decision Support Systems; Defibrillators; Devices; Disease; Economics; Enrollment; Face; Future; Goals; Guidelines; Health Benefit; Health Care Costs; Healthcare; Heart; Heart failure; Hospitalization; Hospitals; Implant; Implantable Defibrillators; Information Technology; Legal patent; Life Expectancy; Linear Regressions; Link; Measures; Medical; Medical Technology; Medicare; Methods; Metoprolol; Metoprolol Succinate; Modeling; Outcome; Participant; Patients; Pharmacologic Substance; Pharmacotherapy; Physicians; Population; Prevalence; Public Health; Publications; Randomized; Recommendation; Relative (related person); Risk; Technology; Time; Treatment Efficacy; Uncertainty; United States Centers for Medicare and Medicaid Services; Veterans; Vital Status; austin; base; carvedilol; clinical care; cohort; college; cost; cost effectiveness; evidence base; expiration; health administration; health care quality; health care service utilization; heart rhythm; implantation; improved; mortality; new technology; patient population; population health; prevent; sudden cardiac death; trend

DESCRIPTION (provided by applicant): Background Chronic heart failure is an extremely common, high-mortality and high-cost disease among older veterans. Several technologies, including devices such as implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy-defibrillators (CRT-Ds), as well as pharmacotherapies such as the beta-blockers carvedilol and extended-release metoprolol, have been demonstrated to reduce mortality among patients with CHF. While some technologies such as ACE- inhibitors currently are used in almost all veterans with CHF, devices and beta-blockers are not yet used in all clinically eligible patients. The costs of these technologies are substantial, and thus it is important to quantify the benefits that these technologies have yielded among veterans with CHF during the past ten years relative to their costs, and it is also critical to identify existing opportunities to improve CHF health care quality at reasonable cost. Objectives The goals of this project are: (1) to examine national trends across VA from 2001-2010 in the use of ICDs/CRTs and carvedilol/metoprolol and to determine if changes in technology use at the VAMC/VISN level were correlated with changes in CHF outcomes; (2) to measure the changes in costs of care for veterans with CHF resulting from the increased use of devices and carvedilol/metoprolol; (3) to identify opportunities for improvement in VA CHF care through greater use of these therapies, estimate the magnitude of the veteran CHF population health benefit that would result from greater technology use, and compare this benefit to the increase in costs to VA that would be necessary for full dissemination of these technologies. Methods This study will use multiple sources of data describing health care utilization and costs among veterans with CHF, including the VA's Medical SAS datasets at the Austin Information Technology Center, VA Decision Support System data, the VA Vital Status File, and linked VA- Centers for Medicare and Medicaid Services datasets that provide information on veterans dually enrolled in both VA and Medicare. We will identify annual cohorts of CHF patients within each VAMC and VISN. We will then examine longitudinal trends in technology use rates, outcomes, and costs among cohorts of heart failure patients across VISNs and VAMCs via hierarchical linear regression models using a "difference-in-difference" approach. These models will then be used to predict costs and benefits of future increases in technology use among VAMCs and VISNs that show evidence of below-target use of newer CHF technologies. Impact This project will investigate how increasing use of evidence-based pharmaceutical and device therapies from 2001-2010 among veterans with chronic heart failure (CHF) has affected clinical outcomes for veterans with this high-mortality disease. As many of the new technologies introduced in the past ten years to treat heart failure are costly, this project will also quantify the rise in VA costs associated with the increasing use of these therapies. The project will illuminate potential opportunities for improvement in CHF outcomes in the VHA by increasing the use of evidence-based therapies. The additional costs to VA of implementing this care also will be forecast. The overarching goal is to provide VA policymakers with information on how technology has impacted the outcomes and costs of CHF care in the recent past, and to predict how technology might influence VA's CHF outcomes and costs in the immediate future.

描述（由申请人提供）： 背景慢性心力衰竭是一种非常常见的，高死亡率和高成本的疾病，在老年退伍军人。一些技术，包括植入式心律转复除颤器（ICD）和心脏起搏治疗-除颤器（CRT-D）等器械，以及β-受体阻滞剂卡维地洛和缓释美托洛尔等药物治疗，已被证明可降低CHF患者的死亡率。虽然ACE抑制剂等一些技术目前用于几乎所有CHF退伍军人，但器械和β受体阻滞剂尚未用于所有临床合格患者。这些技术的成本是巨大的，因此，重要的是量化这些技术在过去十年中相对于其成本在CHF退伍军人中产生的益处，并且确定以合理成本改善CHF医疗保健质量的现有机会也至关重要。目的本项目的目标是：（1）检查2001-2010年VA使用ICD/CRT和卡维地洛/美托洛尔的国家趋势，并确定VAMC/VISN水平的技术使用变化是否与CHF结局变化相关;（2）测量由于增加使用器械和卡维地洛/美托洛尔而导致的CHF退伍军人护理成本变化;（3）通过更多地使用这些疗法来确定改善VA CHF护理的机会，估计更多技术使用将导致的退伍军人CHF人群健康受益的程度，并将该受益与全面传播这些技术所需的VA成本增加进行比较。方法本研究将使用多个数据源描述CHF退伍军人的医疗保健利用率和成本，包括奥斯汀信息技术中心的VA医疗SAS数据集，VA决策支持系统数据，VA生命状态文件，以及链接的VA-医疗保险和医疗补助服务中心数据集，提供退伍军人双重参加VA和医疗保险的信息。我们将在每个VAMC和VISN中确定CHF患者的年度队列。然后，我们将通过分层线性回归模型，使用“差异中的差异”方法，检查VISN和VAMC心力衰竭患者队列中技术使用率、结局和成本的纵向趋势。这些模型将被用来预测未来增加的技术使用的成本和效益的VAMCs和VISN显示出低于目标的使用较新的CHF技术的证据。影响本项目将调查2001-2010年在慢性心力衰竭（CHF）退伍军人中越来越多地使用循证药物和器械治疗如何影响患有这种高死亡率疾病的退伍军人的临床结局。由于过去十年中引入的许多治疗心力衰竭的新技术都很昂贵，因此该项目还将量化与这些疗法使用增加相关的VA成本的增加。该项目将通过增加循证治疗的使用，阐明VHA中CHF结局改善的潜在机会。还将预测退伍军人管理局实施这种护理的额外成本。总体目标是为VA决策者提供有关技术如何影响CHF护理结果和成本的信息，并预测技术如何影响VA在不久的将来的CHF结果和成本。