Value-based Purchasing in Implementation of Depression Care in Community Clinics

基于价值的采购在社区诊所抑郁症护理实施中的应用

• 批准号: 8748476
• 负责人: Yuhua Bao
• 金额: $ 44.16万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8748476
• 关键词: Accident and Emergency department; Accounting; Adopted; Adoption; American; Area; Behavioral; Beryllium; Caring; Chronic Care; Chronic Disease; Clinic; Communities; Community Health; Contracts; County; Data; Databases; Effectiveness; Elements; Enrollment; Environment; Funding; Future; Goals; Health Care Costs; Health Insurance; Healthcare; Hospitalization; Incentives; Knowledge; Learning; Link; Low income; Measures; Mediating; Mediator of activation protein; Medicare; Mental Depression; Mental Health; Modeling; Natural experiment; Outcome; Patients; Performance; Phase; Policies; Population; Primary Health Care; Process; Provider; Registries; Resources; Role; Source; Specific qualifier value; Time; Uninsured; Update; Washington; base; behavioral health; burden of illness; collaborative care; cost; depressive symptoms; design; evidence base; health care service utilization; health organization; improved; meetings; patient population; payment; population health; programs; psychosocial; public health relevance; response; tool

ABSTRACT As many as 40 million low-income Americans will rely on community health clinics (CHCs) for primary care by 2019. Depression and other behavioral health conditions are a major source of disease burden in this population. Implementation of evidence-based behavioral health care is a priority area for CHCs. The goal of this study is to assess the role of Value-Based Purchasing (VBP), a policy strategy, to enhance planned implementation of evidence-based care in CHCs. VBP is a tool to spur quality improvement by linking payment to provider organizations with pre-specified performance targets. The proposed study will leverage a unique VBP program initiated by the Washington State Mental Health Integration Program (MHIP). MHIP implements the CollaborativeCare model, a prominent, evidence-based model to integrate behavioral health care into primary care. MHIP's multi-phase VBP embeds several desirable design features and offers a rare opportunity to produce generalizable findings on the effectiveness of VBP to support implementation of evidence-based chronic care. We will conduct retrospective analysis of existing data based on MHIP registry and health care claims of over 12,000 patients from 52 CHCs in Washington State's King and Pierce Counties. Aims of the study are to assess the effects of MHIP VBP on: 1. Adoption of CollaborativeCare by CHCs; and, 2. Patient outcomes. We will measure adoption based on CHC performance of key process-of-care elements of CollaborativeCare at the patient-episode level. Patient outcomes include depression symptoms, hospitalization, emergency room use and total health care costs. Our analytical strategy will exploit the natural experiment created by the rolling enrollment of patients into MHIP. Specifically, we will compare outcomes pertaining to patient-episodes that occurred pre-, peri-, and post- VBP while controlling for the continuous learning and adopting processes at CHCs. Preliminary data suggest overall low adoption pre-VBP, substantial improvement over time, and CHC behavioral responses to VBP incentives that are consistent with the conceptual framework of the proposed study. This study will generate critical knowledge to assist policymakers with their decisions on whether to use VBP to enhance implementation of evidence-based care in CHCs and how to best design VBP to maximize its impact.

摘要 到2020年，多达4000万低收入美国人将依赖社区卫生诊所(CHCs)提供初级保健 2019年。抑郁和其他行为健康状况是疾病负担的主要来源 人口。实施循证行为保健是社区卫生服务机构的优先领域。的目标是 本研究旨在评估以价值为基础的采购(VBP)这一政策策略在加强计划中的作用 循证护理在社区健康中心的实施。VBP是一种通过关联支付来刺激质量改进的工具 为组织提供预先指定的绩效目标。拟议的研究将利用一个独特的 由华盛顿州精神卫生整合计划(MHIP)发起的VBP计划。MHIP实施 CollaborativeCare模式，一种突出的、基于证据的模式，将行为健康护理整合到 初级保健。MHIP的多相VBP嵌入了几个理想的设计特征，并提供了一个难得的机会 就VBP的有效性提出一般性结论，以支持循证医学的实施 长期护理。我们将根据MHIP注册和医疗保健对现有数据进行回顾分析 华盛顿州金县和皮尔斯县52家社区卫生中心的12000多名患者声称。的目标 研究旨在评估MHIP VBP在以下方面的影响：1.社区卫生中心采用协作护理；以及2.患者 结果。我们将根据CHC的关键护理流程要素的表现来衡量采用率 协作式护理--病人--剧集级别。患者的结果包括抑郁症状， 住院、急诊室使用和医疗保健总费用。我们的分析策略将利用自然 通过滚动登记患者加入MHIP创建的实验。具体地说，我们将比较结果 用于修饰或说明在VBP前、围手术期和后VBP期间发生的、同时控制持续的 在儿童健康中心学习和采用流程。初步数据显示，VBP前整体采用率较低，相当可观 随着时间的推移而改善，以及CHC对VBP激励的行为反应与 拟议研究的概念框架。这项研究将产生关键知识来帮助政策制定者 他们决定是否使用VBP来加强在CHC和 如何最好地设计VBP以最大化其影响。