The Impact of Health Care Reform on Addiction and HIV Services

医疗保健改革对成瘾和艾滋病毒服务的影响

• 批准号: 8535420
• 负责人: CYNTHIA I CAMPBELL
• 金额: $ 23.75万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8535420
• 关键词: Affect; Benchmarking; CD4 Lymphocyte Count; California; Caring; Characteristics; Clinic; Clinical; Comorbidity; Computerized Medical Record; Cost Sharing; Data; Deductibles; Demographic Accounting; Diagnosis; Diagnostic Services; Elements; Enrollment; Future; HIV; HIV Seropositivity; Health; Health Care Costs; Health Care Reform; Health Insurance; Health Planning; Health Policy; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Inpatients; Interview; Measures; Mediating; Medicaid; Medical; Methods; Organizational Change; Organizational Models; Outcome; Patients; Pattern; Phase; Registries; Route; Sampling; Services; Silver; Socioeconomic Status; Statutes and Laws; Substance Use Disorder; System; Time; Treatment Cost; Viral; Vulnerable Populations; Work; addiction; base; cohort; cost; demographics; design; health care delivery; health care service utilization; implementation research; improved; innovation; member; patient population; public health relevance; response; screening; service utilization; theories

DESCRIPTION (provided by applicant): Health care reform legislation has significant implications for access to services and expansion of benefits for those with substance use disorders (SUD), particularly those with HIV. These conditions are associated with multiple medical and psychiatric comorbidities as well as high health care costs. Responding to RFA-DA-13-001, the proposed study focuses on key elements of the Affordable Care Act (ACA) that will be implemented in 2014 and will likely increase demand for SUD and HIV treatment services. The study evaluates the impact of the ACA on individuals with SUDs in a care setting well-suited to ACA implementation research. Kaiser Permanente Northern California (KPNC) is a large health care system providing integrated SUD and medical treatment and has been designated as the statewide benchmark for small group plans in the California health insurance exchange. Our innovative approach is informed by an integrated conceptual model of organizational theory and health service utilization. In this phased study, the Aims of the R21 phase lay the groundwork for analyzing changes in membership demographics and clinical complexity, services use and costs, using a cohort (n=3641) of newly enrolled pre-ACA health plan members with SUDs, including members with both SUDs and HIV. In the R33 phase, we use a pre-post design to compare the R21 cohort to a second, post-ACA cohort of newly enrolled KPNC members with SUDs, using advanced difference-in-difference methods to analyze ACA-related changes that begin in 2014. Key outcomes include membership changes, health services utilization and costs, SUD treatment initiation and retention, and HIV management. The post- ACA cohort will also be followed longitudinally over two years. With an innovative mixed-methods approach, we use data from the health plan's extensive electronic medical record, supplemented by qualitative interviews with organizational and clinical leaders regarding ACA-related changes to benefit plans, service delivery, workforce, and barriers or facilitators that impact ACA implementation. Findings will be highly informative in understanding how health plans implement the ACA and serve newly insured SUD and HIV patient populations, and will contribute to future health policy.

描述（由申请人提供）：医疗改革立法对物质使用障碍（SUD）患者，特别是艾滋病毒感染者获得服务和扩大福利具有重大影响。这些情况与多种医学和精神合并症以及高卫生保健费用有关。为响应RFA-DA-13-001，拟议的研究侧重于将于2014年实施的《平价医疗法案》（ACA）的关键要素，该法案可能会增加对SUD和艾滋病毒治疗服务的需求。该研究评估了ACA在非常适合ACA实施研究的护理环境中对患有sud的个体的影响。Kaiser Permanente北加州（KPNC）是一家大型医疗保健系统，提供综合SUD和医疗服务，并已被指定为加州健康保险交易所小型团体计划的全州基准。我们的创新方法是通过组织理论和卫生服务利用的综合概念模型。在这个分阶段的研究中，R21阶段的目标为分析会员人口统计数据和临床复杂性、服务使用和成本的变化奠定了基础，使用了一个队列（n=3641）新注册的aca前健康计划成员与SUDs，包括SUDs和HIV的成员。在R33阶段，我们使用前后设计来比较R21队列与第二个aca后队列，新入组的KPNC成员患有SUDs，使用先进的差异中差异方法来分析aca相关的变化，这些变化始于2014年。主要成果包括会员变更、卫生服务利用和费用、SUD治疗的开始和保留以及艾滋病毒管理。ACA后的队列也将进行为期两年的纵向跟踪。通过一种创新的混合方法，我们使用来自健康计划广泛的电子病历的数据，辅以对组织和临床领导者的定性访谈，了解ACA相关的福利计划、服务交付、劳动力以及影响ACA实施的障碍或促进因素的变化。研究结果将为了解健康计划如何实施ACA并为新投保的SUD和艾滋病毒患者群体提供大量信息，并将有助于未来的卫生政策。