ADVANCING MEASURES FOR RISK ADJUSTMENT AND PERFORMANCE ASSESSMENT

推进风险调整和绩效评估措施

• 批准号: 8588867
• 负责人: ELLIOTT S FISHER
• 金额: $ 17.73万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-15 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8588867
• 关键词: Accounting; Address; Adoption; Advanced Development; American; Behavioral Risk Factor Surveillance System; Biological Markers; Biometry; Caring; Centers for Disease Control and Prevention (U.S.); Clinical; Code; Collection; Colon Carcinoma; Communities; Consensus; County; Data; Data Reporting; Data Sources; Disease; Electronic Health Record; Foundations; Goals; Group Practice; Growth; Health; Health Planning; Health Sciences; Health Status; Health behavior; Health system; Healthcare; Healthcare Systems; Hip Fractures; Incentives; Incidence; Individual; Information Systems; Instruction; Insurance; Learning; Los Angeles; Malignant neoplasm of lung; Measurement; Measures; Medicare; Medicare claim; Medicare/Medicaid; Methods; Minnesota; Modeling; Monitor; Myocardial Infarction; Online Systems; Outcome; Outcome Assessment; Outcome Measure; Patient Self-Report; Patients; Performance; Physicians; Pilot Projects; Policies; Policy Maker; Population; Primary Health Care; Private Sector; Process Measure; Provider; Public Domains; Public Sector; Quality of Care; Reporting; Retirement; Rewards; Risk; Risk Adjustment; Savings; Science; Socioeconomic Factors; Stroke; Surveys; Symptoms; System; Testing; Wisconsin; Work; base; clinical practice; contextual factors; cost; falls; functional status; health care quality; improved; indexing; innovation; mortality; payment; point of care; prevent; programs; success; tool

PROJECT SUMMARY (See instructions): The health of the American public and the affordability of U.S. healthcare are both threatened by inefficiency in the U.S. healthcare system. A broad array of public and private sector payment and delivery system reforms is underway, the aim of which is to improve care, improve health and slow spending growth. The success of these reforms, however, requires reliable approaches to measuring health quality and costs while accounting for potential differences in patient risk. And while consensus has emerged that current approaches to risk adjustment and performance monitoring have serious limitations, the impending broadscale adoption of electronic health records is expected to enable the routine collection of extensive individual biomarker and patient-reported measures of risk, symptoms and functional status. The current proposal is intended to advance the science of health risk, health outcome and health system performance measurement while helping to address pressing policy needs. The project will draw on important data assembled in Core C: detailed individual risk and health status data from the Health and Retirement Survey (HRS), newly collected patient-level data from three diverse health systems, and comprehensive Medicare claims data. Under the first aim, which focuses on risk adjustment, we will develop two new risk-adjusters: (a) one based on the detailed biometric and patient-reported data collected through the HRS, and (b) a second based on integrating ZIP code and county level measures of health status, mortality and disease incidence. These will be compared to the claims-based measures currently used by Medicare for program payment, with the aim of informing both long-term and interim approaches to improving risk adjustment. Under the second aim, we will use the patient risk and biometric data collected in routine clinical practice to explore potential limitations to using these data for risk adjustment and performance measurement, including assessing the degree to which non-response bias is likely to be problematic, how their routine use in primary care practices is perceived by clinicians, and whether their use contributes to improved care for Medicare patients.

项目摘要（请参阅说明）： 美国公众的健康和美国医疗保健的负担能力都受到美国医疗保健系统效率低下的威胁。正在进行广泛的公共和私营部门支付和交付系统改革，其目的是改善护理，改善健康并减缓支出增长。但是，这些改革的成功需要可靠的方法来衡量健康质量和成本，同时考虑了患者风险的潜在差异。尽管人们已经提出了当前的风险调整和绩效监控方法具有严重的局限性，但预计即将进行的广泛采用电子健康记录的范围将使常规收集广泛的个人生物标志物和患者报告的风险，症状和功能状况。当前的建议旨在提高健康风险，健康结果和卫生系统绩效衡量的科学，同时帮助满足紧迫的政策需求。该项目将借鉴Core C中组装的重要数据：来自健康与退休调查（HRS）的详细个人风险和健康状况数据，来自三个不同卫生系统的新收集的患者级数据以及全面的Medicare索赔数据。在关注风险调整的第一个目标下，我们将开发两个新的风险管理者：（a）一个基于通过HRS收集的详细生物识别和患者报告的数据，以及（b）基于整合邮政编码和县级健康状况，死亡率和疾病率的第二个基础。这些将与Medicare目前用于计划支付的基于索赔的措施进行比较，以告知长期和临时方法以改善风险调整。在第二个目标下，我们将使用常规临床实践中收集的患者风险和生物特征数据来探索使用这些数据进行风险调整和绩效衡量的潜在局限性，包括评估非反应偏见的程度，即可能有问题的是如何在初级保健实践中使用临床医生的常规使用，以及他们的使用是否有助于改善医疗疗法患者的使用。