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: 8292934
• 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/8292934
• 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退伍军人疾病。几项技术，包括植入型心律转复除颤器(ICD)和心脏再同步治疗除颤器(CRT-DS)，以及药物疗法，如β-受体阻滞剂卡维地洛和美托洛尔缓释片，已被证明可以降低CHF患者的死亡率。虽然目前几乎所有患有CHF的退伍军人都使用了ACE抑制剂等一些技术，但并不是所有符合临床条件的患者都使用了设备和β受体阻滞剂。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为患有CHF的退伍军人带来的相对于其成本的好处，也至关重要的是确定现有的机会，以合理的成本改善CHF的医疗保健质量。本项目的目标是：(1)检查2001-2010年退伍军人管理局ICDS/CRT和卡维地洛/美托洛尔使用的全国趋势，并确定VAMC/VISN水平的技术使用的变化是否与CHF结局的变化相关；(2)衡量由于设备和卡维地洛/美托洛尔的使用增加而导致的CHF退伍军人护理费用的变化；(3)确定通过更多地使用这些疗法来改善退伍军人心衰护理的机会，估计更多地使用技术将带来的退伍军人充血性心力衰竭人群健康收益的幅度，并将这种收益与充分传播这些技术所需的退伍军人管理局成本增加进行比较。方法这项研究将使用描述患有CHF的退伍军人的医疗保健利用和费用的多个数据来源，包括奥斯汀信息技术中心的退伍军人医疗SAS数据集、退伍军人决策支持系统数据、退伍军人生命状况文件，以及提供退伍军人同时参加退伍军人保险和医疗保险的相关退伍军人-医疗保险和医疗补助服务中心的数据集。我们将在每个VAMC和VISN中确定CHF患者的年度队列。然后，我们将使用“差别”方法，通过分层线性回归模型，在VISN和VAMC的心力衰竭患者队列中检验技术使用率、结果和成本的纵向趋势。然后，这些模型将被用来预测VAMC和VISN中未来技术使用增加的成本和收益，这些证据表明，较新的CHF技术的使用低于目标。这个项目将调查2001-2010年慢性心力衰竭(CHF)退伍军人中越来越多地使用循证药物和设备疗法如何影响患有这种高死亡率疾病的退伍军人的临床结果。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，该项目还将量化与这些疗法的日益使用相关的VA成本的上升。该项目将阐明通过增加循证治疗的使用来改善VHA中CHF结果的潜在机会。还将预测实施这种护理对退伍军人管理局的额外成本。总体目标是向退伍军人管理局政策制定者提供有关技术在最近过去如何影响CHF护理结果和成本的信息，并预测技术可能如何影响退伍军人管理局在不久的将来的CHF结果和成本。