Impacts of payment reform on racial disparities in hospital psychiatric care

 描述(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，其中包括提高效率的全球资本预算和提高质量的绩效激励。通过鼓励医院满足少数族裔患者未得到满足的需求，这一全面改革有可能减少因精神健康状况而住院的个人在护理协调方面的种族-族裔差异。然而，这种支付改革如果不仔细设计，可能会激励在低收入少数群体城市社区提供精神科护理的“安全网”医院减少精神科服务，以降低成本。在这项研究中，医院管理数据被使用在一个非试验性的差异差异回归框架中，以检验马里兰州的支付改革对安全网和非安全网医院的基于医院的精神科护理中的种族-民族差异的影响。这项研究的主要结果是精神科住院患者住院后接受门诊随访和过渡性护理管理服务，再次住院，以及每位患者在精神科服务上的住院支出。这些影响是通过比较马里兰州(干预州)和宾夕法尼亚州(对照州)在2014年7月前后的变化来确定的。这项拟议的研究意义重大且及时，因为它可以为政策制定者提供信息，帮助他们评估如何在其他州设计类似的“基于价值”的医院支付改革，以改善对少数族裔患者的护理，同时保留低收入少数族裔社区的精神护理安全网。

 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.