Exploring Medicare Provider Networks: Implications for Adoption of CER Findings

探索医疗保险提供者网络：采用 CER 研究结果的影响

• 批准号: 8332819
• 负责人: Jay Bhattacharya
• 金额: $ 19.75万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8332819
• 关键词: Adopted; Adoption; Affect; Area; Cardiac; Caring; Characteristics; Chronic; Chronic Care; Clinical; Coronary; Data; Diabetes Mellitus; Evidence based practice; Expenditure; Future; Geographic Locations; Geography; Goals; Growth; Health; Health Expenditures; Healthcare; Long-Term Care; Medical; Medicare; Medicare claim; Minority; Myocardial Ischemia; Outcome; Outcomes Research; Patients; Patterns of Care; Physicians; Policies; Population; Procedures; Provider; Publications; Publishing; Research; Savings; Seminal; Social Network; Specialist; Stents; Structure; Surgeon; Testing; Time; Variant; Woman; Work; abstracting; base; clinical practice; cohort; comparative effectiveness; cost; cost effective; design; effectiveness research; evidence base; improved; payment; response; virtual

Abstract If comparative effectiveness research (CER) is to reduce health expenditure growth without compromising health outcomes, providers will need to adopt long-term cost-saving strategies that are identified as being no less effective than higher-cost clinical strategies. Understanding how provider "virtual" networks for Medicare influence the cost and content of care may be important when considering health reforms designed to promote the use of lower-cost effective medical care. We propose identifying factors that determine or influence the use of cost-saving yet effective clinical strategies. We further propose investigating the influence of Medicare provider networks (virtual or social networks) and their structure on the cost and content (e.g., evidence-based practices or not) of care provided. Our specific aims are to: 1) determine the extent to which supply and demand factors predict provider adoption of cost-saving evidence-based findings, 2) analyze provider network structure for differences in and influence on the use of evidence-based practices and costs of care, 3) estimate potential Medicare expenditure savings based on policies implementing these findings (perhaps through the use of payment or health reforms such as bundled payments or ACOs). We will base our analysis on the complete Medicare claims files for Parts A and B from years 2005 to 2010 and Part D from 2006 to 2010. Specifically, we will apply these aims to the treatment of patients with chronic stable angina and the use of revascularization with coronary stents before and after evidence-based findings (the COURAGE trial in 2007) were published supporting the initial use of medical management. We will identify the relevant cohort from the Medicare claims files for the time period before and after the time of publication, and identify factors that predicted a change in provider practices from revascularization with stents to medical management in the data. We will control for demographic and patient-level characteristics, investigate ecological and supply determinants, and investigate differences across geographies and patient sub-populations such as women, minorities, and those with diabetes. Next, we will identify provider networks of care for chronic stable angina in the Medicare data, and explore whether provider network structure influences the cost or content of care provided (concordant with evidence-based practices or not). We will explore whether network structures differ across geographies, and whether this partially explains the difference in practice variation and cost between regions. We will identify ways that our findings might be integrated into health reform policies either to optimize the factors we identify as determinants of low-cost yet effective care or to encourage efficient provider network formation. Finally, we will estimate potential Medicare savings based upon these policies.

摘要 如果比较有效性研究（CER）是为了减少卫生支出的增长，而不损害 健康结果，供应商将需要采取长期的成本节约战略，被确定为没有 不如成本更高的临床策略有效。了解医疗保险提供者如何“虚拟”网络 在考虑旨在促进健康的医疗改革时， 使用低成本的有效医疗。 我们建议确定决定或影响使用节省成本但有效的临床 战略布局我们进一步建议调查医疗保险提供者网络（虚拟或社交）的影响 网络）及其关于成本和内容的结构（例如，（或不提供护理）。 我们的具体目标是：1）确定供应和需求因素预测供应商采用的程度 成本节约的循证调查结果，2）分析供应商网络结构的差异和影响 使用循证实践和护理成本，3）估计潜在的医疗保险支出节省 基于实施这些发现的政策（可能通过使用支付或医疗改革， Bundled Payments或ACO）。 我们将根据2005年至2010年A部分和B部分的完整Medicare索赔文件进行分析 2006年至2010年的D部分。具体来说，我们将把这些目标应用于慢性病患者的治疗。 稳定型心绞痛与冠状动脉支架血运重建前后的循证研究结果 (the 2007年发表的COUCHARGE试验）支持最初使用医疗管理。我们将 从医疗保险索赔文件中确定在以下时间段之前和之后的相关队列： 出版物，并确定预测供应商实践从支架血运重建的变化的因素 医疗管理的数据。我们将控制人口统计学和患者水平特征， 调查生态和供应决定因素，并调查不同地区和患者之间的差异 亚人群，如妇女、少数民族和糖尿病患者。接下来，我们将确定提供商网络 慢性稳定型心绞痛的护理在医疗保险的数据，并探讨是否提供者网络结构 影响所提供护理的成本或内容（是否符合循证实践）。我们将 探索网络结构是否因地理位置而异，以及这是否部分解释了这种差异 在实践中，各区域之间差异和成本。我们将确定我们的研究结果可能被整合到 卫生改革政策，以优化我们确定为低成本但有效护理的决定因素， 鼓励有效的供应商网络形成。最后，我们将估计潜在的医疗保险储蓄的基础上， 这些政策。