The Impact of Health Homes in New York State on People with Substance Use Disorde

纽约州健康之家对药物滥用患者的影响

• 批准号: 8534528
• 负责人: JON MORGENSTERN
• 金额: $ 22万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 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/8534528
• 关键词: AIDS/HIV problem; Accident and Emergency department; Accounting; Adult; Aftercare; Agreement; Alcohol or Other Drugs use; Amendment; Behavioral; Budgets; Caring; Case Manager; Chronic; Chronically Ill; Client; Clinical; Cost Control; Data; Data Set; Development; Drug Metabolic Detoxication; Enrollment; Ensure; Feedback; Fostering; Funding; Glycosylated hemoglobin A; HIV Seropositivity; Health; Health Care Costs; Health Care Reform; Healthcare; Home environment; Homelessness; Hospitals; Individual; Inpatients; Logistic Regressions; Measures; Mediator of activation protein; Medicaid; Medical; Mental Health; Mental disorders; Metric; Modeling; Mood stabilizers; New York; Outcome; Outcome Measure; Patient-Centered Care; Patients; Performance; Phase; Population; Primary Health Care; Provider; Quality Indicator; Quality of Care; Records; Registries; Regression Analysis; Rehabilitation therapy; Research; Research Infrastructure; Scoring Method; Series; Subgroup; Substance Use Disorder; Testing; Time; Viral Load result; Visit; Vulnerable Populations; Writing; addiction; administrative database; base; chronic care model; comparison group; cost; demographics; diabetic; health care service utilization; health information technology; high risk; improved; longitudinal design; pressure; programs; public health relevance; severe mental illness; stem

DESCRIPTION (provided by applicant): The expansion of healthcare coverage through Medicaid will allow greater access to SUD treatment among those who currently do not have coverage. However, States will be concerned about cost containment as expansion of coverage will increase pressures on strained budgets. Health Homes (HHs) are a federally funded Medicaid program-authorized by the Affordable Care Act-to improve quality of care and reduce wasteful spending for chronic medical and behavioral conditions. HHs aim to increase patient centered care among the most vulnerable populations covered under Medicaid. New York (NY) has received federal approval and is currently rolling out its HH program statewide (anticipated enrollment of about 750,000). The NY HHs program has distinct features including a focus on SUD among enrollees with chronic medical and mental health disorders, fostering of local partnerships among diverse types of providers, and use of care managers to ensure patient centered care. Using a longitudinal design, this study will examine whether the NY HH program improves quality of care, reduces inefficient healthcare, and lowers costs among the 120,000/year individuals with SUD who are eligible for HHs in NY. Administrative data from 2006 through 2016 will be derived from a combination of Medicaid claims and encounters and SUD state registry records which include socio- demographics and substance use data. The study will occur in two phases. In the R21 Phase (1 Year), Primary Aims focus on putting a research infrastructure in place by establishing written agreements with state agencies, creating analytical datasets, and developing a statistical description of initial HH enrollees. Data analysi will include using descriptive and mixed effects logistic regression analyses to describe and contrast historical and baseline socio-demographic, clinical and healthcare utilization among subgroups (e.g., HH eligible with no SUD; high risk clients with SUD). In the R33 Phase (4 years), Primary Aims include examining whether HHs improve Medicaid quality indicators of SUD treatment, quality of medical and mental health care among SUD clients, efficiency of healthcare (e.g., avoidable rehospitalizations), as well as reduce Medicaid costs. Mixed effects logistic regression models will examine changes from historical rates of quality of care metrics and of costs while controlling for a variety of factors (e.g., individual clinically complicating factors). Generalized gamma models will be used to examine Medicaid costs by year. Secondary Aims focus on providing further evidence for making causal inferences about the effect of HHs on outcomes. Regression analyses will explore the relationship between HH program and quality and costs by comparing enrollees to statistically matched non-enrollees, examining the association between care manager activity and outcomes, and the association between moderators (e.g., homelessness) and mediators (e.g., primary care engagement) with efficiency and costs. Findings will have relevance as other states expand Medicaid coverage and use similar reform efforts for chronic conditions targeting the costliest and neediest populations.

描述（由申请人提供）：通过医疗补助扩大医疗保险范围将使目前没有保险的人更容易获得SUD治疗。然而，各国将关注费用控制问题，因为扩大覆盖面将增加对紧张预算的压力。健康之家（HHS）是一个由联邦政府资助的医疗补助计划，由《平价医疗法案》授权，旨在提高护理质量，减少慢性医疗和行为疾病的浪费性支出。卫生部的目标是在医疗补助计划覆盖的最脆弱人群中增加以病人为中心的护理。纽约（NY）已获得联邦批准，目前正在全州范围内推出HH计划（预计注册人数约为75万人）。纽约卫生署计划具有鲜明的特点，包括关注慢性医疗和精神健康障碍的注册者中的SUD，促进不同类型的提供者之间的当地合作伙伴关系，以及使用护理经理来确保以患者为中心的护理。使用纵向设计，本研究将检查纽约HH计划是否提高了护理质量，减少了低效的医疗保健，并降低了120，000/年有资格在纽约享受HH的SUD患者的成本。2006年至2016年的行政数据将来自医疗补助索赔和遭遇以及SUD州登记记录的组合，其中包括社会人口统计学和物质使用数据。研究将分两个阶段进行。在R21阶段（1年），主要目标侧重于通过与州机构建立书面协议、创建分析数据集以及开发初始HH注册者的统计描述来建立研究基础设施。数据分析将包括使用描述性和混合效应逻辑回归分析来描述和对比亚组之间的历史和基线社会人口统计学、临床和医疗保健利用（例如，符合条件但无SUD的HH;有SUD的高风险客户）。在R33阶段（4年），主要目的包括检查卫生保健机构是否改善了SUD治疗的医疗补助质量指标、SUD客户的医疗和精神卫生保健质量、医疗保健效率（例如，可避免的再住院），以及减少医疗补助费用。混合效应逻辑回归模型将检查护理质量指标和成本的历史比率的变化，同时控制各种因素（例如，个别临床复杂因素）。广义伽马模型将用于检查医疗补助费用按年。次要目的侧重于提供进一步的证据，以便对HH对结局的影响进行因果推断。回归分析将通过比较注册者与统计学匹配的非注册者，检查护理经理活动与结果之间的关联以及调节者（例如，无家可归者）和调解员（例如，初级保健参与）与效率和成本。随着其他州扩大医疗补助覆盖范围，并针对最昂贵和最需要的人群进行类似的慢性病改革努力，调查结果将具有相关性。

项目成果

Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes.

药物使用障碍和糖尿病护理：纽约健康之家的经验教训。

• DOI: 10.1097/mlr.0000000000001602
• 发表时间: 2021-10-01
• 期刊: Medical care
• 影响因子: 3
• 作者: Forthal S;Choi S;Yerneni R;Zhang Z;Siscovick D;Egorova N;Mijanovich T;Mayer V;Neighbors C
• 通讯作者: Neighbors C