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: 8840210
• 负责人: JON MORGENSTERN
• 金额: $ 57.56万
• 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 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8840210
• 关键词: AIDS/HIV problem; Accounting; Adult; Aftercare; Agreement; Alcohol or Other Drugs use; Amendment; Behavioral; Bipolar I; Budgets; Caring; Case Manager; Chronic; Chronically Ill; Client; Clinical; Cost Control; Data; Data Analyses; Data Set; Development; Drug Metabolic Detoxication; Emergency department visit; 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; 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; diabetic; health care service utilization; health information technology; high risk; improved; longitudinal design; pressure; programs; severe mental illness; stem

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 programauthorized by the Affordable Care Actto 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 sociodemographics 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 analysis 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.

通过医疗补助扩大医疗保健覆盖范围将使更多人获得 SUD 治疗 目前没有保险的人。然而，各国将担心成本控制，因为 覆盖范围的扩大将增加紧张预算的压力。健康之家 (HH) 是联邦机构 由《平价医疗法案》授权的资助医疗补助计划，旨在提高护理质量并减少 用于慢性医疗和行为状况的浪费性支出。 HH 旨在加强以患者为中心的护理 属于医疗补助覆盖的最弱势群体。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 750,000 人）。纽约州 HH 计划具有鲜明的特点，包括重点关注患有慢性病和精神疾病的参与者的 SUD 健康障碍，促进不同类型提供者之间的当地伙伴关系，以及利用护理管理人员来 确保以患者为中心的护理。本研究将采用纵向设计来检验 NY HH 计划是否 提高护理质量，减少低效的医疗保健，并降低每年 120,000 人的成本 有资格获得纽约州 HH 的 SUD。 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（包括社会人口统计数据）的组合 和物质使用数据。该研究将分两个阶段进行。在 R21 阶段（1 年），小学 目标重点是通过与国家建立书面协议来建立研究基础设施 机构，创建分析数据集，并开发初始 HH 登记者的统计描述。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、临床和医疗保健利用率（例如，HH 没有 SUD 资格； SUD 的高风险客户）。在 R33 阶段（4 年），主要目标包括审查 家庭是否改善 SUD 治疗的医疗补助质量指标、医疗和心理保健质量 在 SUD 客户中，医疗保健效率（例如，可避免的再住院）以及减少医疗补助 成本。混合效应逻辑回归模型将检查历史护理质量率的变化 指标和成本，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按年检查医疗补助成本。次要目标集中于 为对 HH 对结果的影响做出因果推断提供进一步的证据。回归 分析将通过比较参与者来探讨 HH 计划与质量和成本之间的关系 统计匹配的非参与者，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）和调解者（例如初级保健参与）之间的关联 具有效率和成本。随着其他州扩大医疗补助覆盖范围和使用，研究结果将具有相关性 针对慢性病的类似改革努力针对的是最昂贵和最贫困的人群。