Estimating Costs of Supporting Safety-Net PCMH Transformation in New Orleans

估算支持新奥尔良安全网 PCMH 转型的成本

• 批准号: 8628492
• 负责人: LIZHENG SHI
• 金额: $ 10万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628492
• 关键词: Estimating; Costs; Supporting; Safety; Net

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) is one promising model for transforming the organization and delivery of primary care in order to achieve high-quality, accessible, and efficient health care. To date, much of the PCMH evaluation has focused on the success of improving quality outcomes in large integrated delivery systems. There is an urgent need to understand the costs associated with supporting, implementing, and maintaining systematic redesign of small and medium sized primary care practices that serve American's most vulnerable populations (i.e., the safety net). The safety net health care system in Greater New Orleans after Hurricane Katrina embarked on a system-wide effort to rebuild and transform primary care by using the PCMH model, which was supported by a $100-million federal grant called the Primary Care Access and Stabilization Grant (PCASG). The preliminary results have demonstrated an improved patient rating of care coordination among the PCASG clinics. Our long-term goal is to provide comprehensive evidence to support the implementation and sustainability of primary care practice change in the United States using the PCASG program as a "natural experiment" in years 2007-2011. There is a dearth of data to estimate the cost effects of PCMH transformation from the perspective of individual clinics to further improve efficient, effective, and sustainable PCMH models. Therefore, the primary aim of this cost evaluation will be to quantify the direct and indirect costs shouldered by New Orleans small and medium sized safety net practices in becoming PCMHs and external non-financial costs involved in PCMH redesign and implementation activities. We will use the PCASG program data including patient encounters, services delivery register, operating budget and revenues, and PCMH scores. We will separate total costs into direct and indirect costs of safety net practices according to the PCASG program cost categories (direct cost: clinical and specialty care; indirect cost: administrative). The cost measures (e.g., cost per patient per month and cost per full-time equivalent (FTE) physician) derived from PCMH clinics and non-PCMH clinics will be further summarized in terms of baseline practice expense, incremental cost of PCMH transformation, and maintenance of practice change. The external non-financial incentives will also be included in the cost evaluation. The secondary aim will be to examine the associations between clinic-level characteristics and cost measures in primary care practices over the period of the PCASG program. Using the PCASG data sources, we will employ difference-in-difference longitudinal models to analyze the influencing factors of the cost measures under the PCASG program. This cost evaluation project will provide key stakeholders (e.g., primary care practices, health care systems, health care payers, and health policy makers) with information about the costs of transformative primary care practice redesign and implementation and make recommendations on future initiatives for primary care change in the United States.

描述（由申请人提供）：以病人为中心的医疗之家（PCMH）是一种很有前途的模式，它改变了初级保健的组织和提供方式，以实现高质量、可获得和高效的卫生保健。迄今为止，大部分PCMH评估都集中在大型综合交付系统中改善质量结果的成功。迫切需要了解与支持、实施和维护为美国最弱势人群（即安全网）服务的中小型初级保健实践系统重新设计相关的成本。卡特里娜飓风过后，大新奥尔良地区的安全网卫生保健系统启动了一项全系统努力，通过使用PCMH模式重建和改造初级保健，该模式得到了1亿美元的联邦赠款，即初级保健获取和稳定赠款（PCASG）的支持。初步结果表明，PCASG诊所之间的护理协调改善了患者评级。我们的长期目标是提供全面的证据来支持美国初级保健实践变革的实施和可持续性，将PCASG项目作为2007-2011年的“自然实验”。从个体诊所的角度估计PCMH转型的成本效应，以进一步提高效率、效果和可持续的PCMH模式，缺乏数据。因此，这项费用评价的主要目的将是量化新奥尔良中小型安全网在成为私营保健医院方面所承担的直接和间接费用，以及私营保健医院重新设计和执行活动所涉及的外部非财务费用。我们将使用PCASG项目数据，包括患者就诊情况、服务提供登记、运营预算和收入以及PCMH评分。我们将根据PCASG项目成本类别（直接成本：临床和专科护理；间接成本：行政管理）将总成本分为安全网实践的直接成本和间接成本。从PCMH诊所和非PCMH诊所获得的成本措施（例如，每个病人每月的成本和每个全职等效（FTE）医生的成本）将根据基线执业费用、PCMH转换的增量成本和执业变化的维护进行进一步总结。外部的非财政奖励也将列入成本评价。第二个目的将是检查在PCASG项目期间初级保健实践中临床水平特征和成本措施之间的关系。利用PCASG数据来源，我们将采用差中差纵向模型来分析PCASG项目下成本措施的影响因素。该成本评估项目将为主要利益相关者（如初级保健实践、卫生保健系统、卫生保健支付方和卫生政策制定者）提供有关重新设计和实施变革性初级保健实践成本的信息，并就美国初级保健变革的未来举措提出建议。

项目成果

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.

估算卡特里娜飓风过后新奥尔良支持安全网转变为以患者为中心的医疗之家的成本。

• DOI: 10.1097/md.0000000000004990
• 发表时间: 2016
• 期刊: Medicine
• 影响因子: 1.6
• 作者: Shao,Hui;Brown,Lisanne;Diana,MarkL;Schmidt,LauraA;Mason,Karen;Oronce,CarlosIrwin;Shi,Lizheng
• 通讯作者: Shi,Lizheng