EHR-Based Measurement of Care Coordination in an Accountable Care Organization

项目摘要/摘要 最近不断增加的费用和不断下降的医疗保健，特别是在慢性病患者中，已经 导致了重大的医疗保健提供和支付改革举措。改革的一种方法包括 建立负责任的护理组织(ACO)、提供者团体和卫生保健 为确定的患者群体提供协调护理的组织。有效的护理协调 有潜力通过减少可预防的医院来实现质量改进和成本控制 入院和再入院，减少急诊科就诊，改善护理过渡。 然而，不存在能够产生全面、实时、 护理协调的可量化测量。我们的长期目标是改善护理协调 通过ACOS改善慢性病患者的预后并降低成本。我们的整体 本R03提案的目标是实施基于电子病历的护理协调措施，制定 框架说明了在ACO环境中衡量护理协调的关键领域，并映射了每个 基于EHR的框架域措施。我们计划到2010年完成我们的总体目标 追求以下两个具体目标：1)实施基于电子病历的措施，以评估护理协调情况 在ACO中，以及2)开发基于EHR的措施并将其映射到ACO护理的关键域框架 协调。这项建议意义重大，因为它扩展了先前的研究，以促进更及时、更多 全面、更准确的ACO评估，因此可以帮助确定护理领域 在电子健康记录和ACO中都可以改进的协调，以改善医疗保健 提高患者的质量，降低患者的成本。

Project Summary/Abstract Recently increasing costs and declining health care, particularly in patients with chronic diseases, have led to major health care delivery and payment reform initiatives. One approach to reform includes the establishment of accountable care organizations (ACOs), groups of providers and health care organizations who deliver coordinated care to a defined patient population. Effective care coordination has the potential to achieve quality improvement and cost control by reducing preventable hospital admissions and readmissions, decreasing emergency department visits, and improving care transitions. However, no single measure or set of measures exists that is able to produce comprehensive, real-time, quantifiable measurements of care coordination. Our long-term goal is to improve care coordination through ACOs to improve outcomes and reduce costs in patients with chronic diseases. Our overall objectives in this R03 proposal are to implement EHR-based care coordination measures, develop a framework illustrating key domains for measuring care coordination in the ACO context, and map each of the EHR-based measures to the framework domains. We plan to accomplish our overall objective by pursuing the following two specific aims: 1) Implement EHR-based measures to assess care coordination in an ACO, and 2) Develop and map EHR-based measures to a framework of key domains for ACO care coordination. This proposal is significant, because it extends prior research to facilitate timelier, more comprehensive, and more accurate ACO evaluations, and, as a result can help identify areas of care coordination that can be improved in both electronic health records and ACOs to improve health care quality and reduce costs in patients.