Impacts of payment reform on racial disparities in hospital psychiatric care

 描述（由申请人提供）：2014年7月，马里兰州实施了全州范围的医院支付改革，其中包括全球资本预算，以提高效率和绩效激励，以提高质量。通过鼓励医院解决少数民族患者未得到满足的需求，这一全面的变化有可能减少因精神健康状况住院的个人在护理协调方面的种族-民族差异。然而，如果不仔细设计，这种支付改革可能会激励“安全网”医院为低收入少数民族城市社区提供精神病护理，减少提供精神病服务以降低成本。在这项研究中，医院的行政数据被用于在一个非实验性的差异中的差异中的差异回归框架，以检查的影响，马里兰州支付改革的种族种族差异，以医院为基础的精神病护理在安全网和非安全网医院。该研究的主要结果是接受门诊随访和过渡性护理管理服务后，精神科住院，再入院，和每名患者的精神科服务的医院支出。这些影响是通过比较2014年7月前后马里兰州（干预州）和宾夕法尼亚州（比较州）的变化来确定的。这项拟议的研究是重要和及时的，因为它可以告知政策制定者评估如何在其他州设计类似的“基于价值”的医院支付改革，以改善对少数民族患者的护理，同时保留低收入少数民族社区的精神病护理安全网。

 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.