New York State Health Home Impact on HIV Treatment Cascade

说明(由申请人提供)：为了减缓艾滋病毒/艾滋病患者的传播，改善艾滋病毒/艾滋病患者的健康状况，《平价医疗法案》大大扩大了低收入艾滋病毒/艾滋病患者获得医疗保健的机会。此外，国家艾滋病政策办公室制定了一项战略，通过弥合艾滋病毒护理连续体中的差距来改善目前的护理制度。艾滋病毒护理连续体概述了应对感染的一系列步骤：a)艾滋病毒检测，b)参与艾滋病毒护理，c)参与抗逆转录病毒治疗(ART)，d)最终目标--病毒抑制。监测数据描绘了美国连续护理的惨淡图景，只有不到25%的PLWHA具有无法检测到的病毒载量。鉴于当前卫生保健系统支离破碎、危机驱动的性质，无家可归或住房不稳定的个人可能继续得到低质量的护理，或者根本得不到护理。在住房不稳定、艾滋病毒阳性的个人中，药物使用障碍、精神疾病和其他慢性病的高流行率增加了让这一群体参与护理的难度。《平价医疗法案》包括一些针对慢性病管理的重要医疗系统重组条款，其中包括为接受医疗补助的人设立的健康之家。纽约(NY)卫生部(DOH)创建了美国最早和最雄心勃勃的HHS实施之一。NY HH是由医疗和行为健康提供者组成的新形成的综合保健网络，通过共享护理管理者和公共技术平台签约提供综合保健。此外，纽约州卫生部还有一项试点计划，为参加HHS的无家可归者提供544套支持性住房(SH)。这项研究将测试1)SH与HHS相结合是否提高了544名无家可归的PLWHA HH参与者的护理质量，以及2)纽约HH是否改善了参加HHS的8,250名Medicaid无家可归的PLWHA的护理质量和成本。主要目标将通过两种方式实现。首先，我们将使用非参数差异法比较上海无家可归的PLWHA和那些没有获得支持性住房的人的HIV连续体和其他质量指标和医疗补助费用。其次，我们将使用2009至2016年的行政数据实施纵向设计，以检查医疗补助中无家可归者PLWHA的护理质量和医疗补助成本的变化。该项目来自学术和公共部门的合作伙伴关系，以解决医疗体系重新设计的高度优先问题。数据将来自在纽约进行的所有艾滋病毒实验室测试的监测数据，医疗补助遭遇/索赔，以及HHS关于客户功能和护理经理联系方式的报告。这些数据将由卫生部合并以创建DE识别的分析数据集。其他定性研究方法将被用来阐明与结果相关的HH因素。如果目标得以实现，这项研究可能会对提高人们对解决无家可归者问题的循证方法的认识产生重大影响。此外，由于研究干预是ACA的一部分，研究结果对国家医疗保健的政策影响可能是巨大的。

DESCRIPTION (provided by applicant): In order to slow the spread of HIV and improve health outcomes for persons living with HIV/AIDS (PLWHA), the Affordable Care Act greatly expands access to health care for low-income PLWHA. Further, the Office of National AIDS Policy has created a strategy to improve the current system of care by closing gaps in the HIV care continuum. The HIV care continuum outlines a series of steps in addressing infection: a) HIV testing, b) engagement in HIV care, c) participation in antiretroviral therapy (ART), and d) the ultimate target-viral suppression. Surveillance data paint a dismal picture of the continuum of care in the United States, with less than 25% of PLWHA having undetectable viral load. Given the fragmented, crisis-driven nature of the current health care system, individuals who are homeless or unstably housed may continue to receive low quality care or no care at all. The high prevalence of substance use disorders, mental illness, and other chronic illnesses among unstably housed, HIV-positive individuals increases the difficulty in engaging this group in care. The Affordable Care Act includes a number of important healthcare system restructuring provisions for chronic illness management, among which are Health Homes (HH) for Medicaid recipients. New York (NY) Department of Health (DOH) has created one of the country's earliest and most ambitious implementations of HHs. NY HH's are newly formed integrated healthcare networks of medical and behavioral health providers that contract to provide integrated care through shared care managers and common technology platforms. Additionally, NY DOH has a pilot program to provide 544 units of supportive housing (SH) for homeless PLWHA enrolled in HHs. This study will test 1) whether SH combined with HHs improves quality of care for 544 homeless PLWHA HH enrollees and 2) whether New York HH improve quality of care and costs to 8,250 Medicaid homeless PLWHA enrolled in HHs. The primary aims will be addressed in two ways. First, we will compare HIV continuum and other quality metrics and Medicaid costs between homeless PLWHA in SH and those who did not receive supportive housing using nonparametric difference-in-difference methods. Second, we will implement a longitudinal design using administrative data from 2009 through 2016 to examine changes in quality of care and Medicaid costs for homeless PLWHA in Medicaid. The project comes from an academic- public sector partnership to address high priority questions of healthcare system redesign. Data will come from surveillance data on all HIV lab tests conducted in NY, Medicaid encounters/claims, and from HHs reporting on client functioning and care manager contacts. These data will be merged to create DE identified analytical datasets by DOH. Additional qualitative research methods will be employed to elucidate the HH factors associated with outcomes. If aims are achieved, the study is likely to have a major impact on improving knowledge about evidence-based approaches to address homeless PLWHA. In addition, because the study intervention is part of ACA, the policy impact of the study findings on national healthcare may be substantial.