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Impacts of payment reform on racial disparities in hospital psychiatric care

支付改革对医院精神科护理种族差异的影响

基本信息

批准号：
9120420
负责人：
ERIC SLADE
金额：
$ 49.31万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-04 至 2019-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9120420
关键词：
Address Affect Budgets Calendar Caring Communities Complex Data Databases Ethnic Origin Health Health Services Accessibility Healthcare Hospital Costs Hospital safety Hospitalization Hospitals Incentives Income Individual Inpatients Intervention Low income Maryland Mental Health Methods Minority Modeling Outpatients Patients Pennsylvania Performance Policies Population Provider Psyche structure Psychiatric Hospitals Psychiatric therapeutic procedure Race Research Rewards Risk Services Severity of illness System base capitate bone cost design disparity reduction flexibility follow-up health care disparity health disparity hospital readmission hospital utilization improved innovation inpatient service medical specialties payment primary outcome programs prospective racial and ethnic disparities racial disparity safety net service utilization

项目摘要

DESCRIPTION (provided by applicant): In July 2014, Maryland implemented a statewide hospital payment reform that includes global capitated budgeting to increase efficiency and performance incentives to improve quality. By encouraging hospitals to address the unmet needs of minority patients, this sweeping change has the potential to reduce racial-ethnic disparities in care coordination for individuals who are hospitalized as a result of a mental healt condition. However, such payment reforms, if not carefully designed, could incentivize "safety-net" hospitals, which provide access to psychiatric care in low-income minority urban communities, to offer fewer psychiatric services in order to reduce costs. In this study, hospitals administrative data are used in a non-experimental difference-in-difference-in-differences regression framework to examine the effects of the Maryland payment reform on racial-ethnic disparities in hospital-based psychiatric care at safety-net and non-safety-net hospitals. The study's primary outcomes are receipt of outpatient follow-up and transitional care management services after a psychiatric inpatient stay, hospital readmission, and hospital spending per patient for psychiatric services. These impacts are identified by comparing changes in Maryland (the intervention state) with changes in Pennsylvania (the comparison state) after, versus before, July 2014. This proposed study is significant and timely because it can inform policymakers' assessments of how similar "value- based" hospital payment reforms in other states can be designed to improve care for minority patients while preserving the psychiatric care safety-net in low-income minority communities.