Implementing Health Plan-Level Care Management for Solo & Small Practices

描述(由申请人提供)：2011年HHS关于多种慢性病的报告强调了与共生慢性病相关的患病率、发病率和成本，包括身体和精神上的慢性病。协作式慢性护理模式(CCM)在治疗慢性医疗和精神疾病方面是有效的，几乎没有净医疗成本。到目前为止，CCM主要在设施级别实施，并被较大的公共医疗保健组织采用。然而，绝大多数提供商业保险护理的初级保健和行为健康实践都太小，无法实施这种模式。健康计划层面的合作伙伴关系可以解决这一未得到满足的需求。基于与Aetna Inc.的开创性合作伙伴关系，这项研究的目标是实施一种交叉诊断CCM，旨在改善情绪障碍患者的结果，着眼于为可推广的计划级CCM开发业务案例，用于单独或小型实践。情绪障碍(抑郁症和双相情感障碍)被安泰确定为优先疾病，因为他们的慢性性质和高昂的医疗费用。虽然循证护理参数已经建立得很好，但对于情绪障碍患者来说，医疗和精神护理的质量以及健康结果并不是最理想的。我们将在全国各地因单相抑郁或双相情感障碍住院并在单独或小型初级保健或行为健康实践中接受治疗的安泰受益人中进行交叉诊断CCM与教育对照的随机对照试验。在住院出院时，总共涉及344名患者的172项单独或小型实践将被随机分配到由CCM或教育对照扩大的一年门诊治疗中。CCM组件包括由盐湖城Aetna护理管理中心实施的完全远离练习场地和患者的护理管理、提供者指南支持和基于网络的自我管理支持(Life Goals Program)。主要的健康结果是情绪障碍症状、与健康相关的生活质量、住院以及基于指南的情绪障碍和心脏代谢管理。次要成果包括确定与CCM成果和采纳相关的提供者和组织因素，包括卫生信息技术能力、CCM相对于教育控制的成本效益，以及根据经验数据和利益攸关方投入制定业务计划。拟议的R18涉及AHRQ的研究示范和传播优先事项，特别是关于预防和护理管理。除了这种突破性的实践-研究伙伴关系侧重于单独或小型实践，以在健康计划层面进一步实施CCM之外，这项研究还可能导致一般交叉诊断CCM的业务案例的演变，以及计划级小组管理和远程电子健康技术的使用，特别是随着负责任的护理组织和类似倡议的出现。

DESCRIPTION (provided by applicant): The 2011 HHS report on multiple chronic conditions highlighted the prevalence, morbidity, and cost associated with clusters of co-occurring chronic conditions, both physical and mental. Collaborative chronic care models (CCMs) are effective in treating chronic medical and mental illnesses at little to no net healthcare cost. To date CCMs have primarily been implemented at the facility level and adopted by larger, public healthcare organizations. However, the vast majority of primary care and behavioral health practices providing commercially insured care are far too small to implement such models. Health plan-level CCMs can address this unmet need. Based on a groundbreaking partnership with Aetna Inc., the goal of this study is to implement a cross-diagnosis CCM designed to improve outcomes for persons with mood disorders with an eye towards developing a business case for a generalizable plan-level CCM for solo or small practices. Mood disorders (depression and bipolar disorder) were identified by Aetna as priority conditions because of their chronic nature and high healthcare costs. While evidence-based care parameters have been well established, quality of medical and psychiatric care and health outcomes are suboptimal for persons with mood disorders. We will conduct a randomized controlled trial of the cross-diagnosis CCM vs. education control among Aetna beneficiaries across the country who were hospitalized for unipolar depression or bipolar disorder and treated in solo or small primary care or behavioral health practices. At hospitalization discharge a total of 172 solo or small practices involving a total of 344 patients will be randomized to one year of outpatient treatment augmented by the CCM or education control. CCM components include care management that will be fully remote from practice venues and patients, implemented by the Aetna care management center in Salt Lake City, provider guideline support, and web-based self-management support (Life Goals program). The primary health outcomes are mood disorder symptoms, health-related quality of life, hospitalizations, and guideline- based mood disorders and cardiometabolic management. Secondary outcomes include determining the provider and organizational factors associated with CCM outcomes and uptake including health IT capacity, cost effectiveness of the CCM compared to education control, and development of a business plan based on empirical data and stakeholder input. This proposed R18 addresses AHRQ's research demonstration and dissemination priorities, particularly around prevention and care management. In addition to this groundbreaking practice-research partnership focused on solo or small practices to further implement CCMs at the health plan level, this study may also lead to the evolution of the business case for cross-diagnosis CCMs in general, and the utility of plan-level panel management and remote e-health technologies, especially with the advent of accountable care organizations and similar initiatives.