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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

基本信息

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
项目类别：
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

项目摘要

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险范围将允许更多的人获得SUD治疗