Characterization and effect of co-existence of care management programs for high need, high cost older adults

一小部分人口占医疗保健支出的大部分。这些人 更有可能是65岁以上的成年人，他们经常使用医疗保健服务 多种慢性病和/或功能障碍。这些“高需求、高成本”的老年人 可能会经历零散的护理、因可预防的疾病而住院、实验室和用药错误， 以及对他们的照顾的不满。护理管理计划可能是一种很有前途的方法 人口。医疗保健环境的变化导致了这些计划的激增；估计 建议现在的护理管理项目是10年前的3倍。其中许多 目前，方案是在独立实体内制定的，如门诊诊所、急性护理医院 和负责任的护理组织，这些组织传统上不合作；这意味着，可以有多个计划 在不知情的情况下试图管理对单个人的护理。目前还不清楚护理管理计划是如何 在照顾高需求、高成本的老年人口方面共存。这项提议旨在填补这一重要的 通过评估护理管理方案共存的范围、性质和影响来实现差距 高需要高消费的老年人。目标1侧重于来自多个潜在的护理管理计划 来源(健康计划、初级和专科门诊护理、急性住院护理和家庭护理) 大型学术卫生系统。对计划管理员的结构化调查将评估计划 特点。来自这些计划的登记患者的数据将进行交叉匹配并与 综合卫生保健利用数据，以检查人口规模、人口统计和临床特征 高需求、高成本的老年人参加了共同存在的护理管理计划。目标2 通过进行深入访谈和定性数据分析来扩展目标1的调查结果，以探索 高需求、高成本的老年人和一线项目工作人员(即案例经理)的观点 感知和观察到共存的护理管理服务对管理健康和 协调护理。这项提案所在的学术卫生系统位于一个区域内 卫生系统的伙伴关系。这里的发现将成为未来研究更大的 在整个区域合作伙伴关系中，护理管理计划的景观共存。这是一项创新 工作解决了来自多个来源的护理管理计划如何在高需求的护理中共存， 高消费的老年人。如果不了解程序如何共存，就很难将结果归因于 任何一次干预，阻碍了确定最佳做法和改善对弱势群体的护理的进展 人口。拟议的项目将支持候选人的职业发展，他的目标是成为 一名独立的临床医生调查员，专注于确定最佳实践，以改善对高需求、高 让老年人付出代价。

A small segment of the population accounts for the majority of health care spending. These individuals are disproportionately likely to be adults over 65 years old who are frequent users of health care services due to multiple chronic conditions, and/or functional impairment. These “high need, high cost” older adults are more likely to experience fragmented care, hospitalizations for preventable conditions, lab and medication errors, and dissatisfaction with their care. Care management programs may be a promising approach for this population. Changes in the health care environment have led to a proliferation of these programs; estimates suggest that 3 times as many care management programs exist today as just 10 years ago. Many of these programs are currently developed within independent entities such as outpatient clinics, acute care hospitals and accountable care organizations that do not traditionally collaborate; meaning, more than one program may unknowingly attempt to manage the care of a single individual. It is not clear how care management programs co-exist in the care of the high need, high cost older adult population. This proposal aims to fill this important gap by assessing the scope, nature and effects of co-existence of care management programs which target high need high cost older adults. Aim 1 focuses on care management programs from a number of potential sources (health plans, primary and specialty outpatient care, acute inpatient care, and home care) within a large academic health system. Structured surveys of program administrators will assess program characteristics. Data on enrolled patients from these programs will be cross-matched and linked with aggregated health care utilization data to examine the population size, demographic and clinical characteristics of high need, high cost older adults who are enrolled in co-existing care management programs. Aim 2 extends Aim 1 findings by conducting in-depth interviews and qualitative data analysis to explore the perspectives of high need, high cost older adults and frontline program staff (i.e.- case managers) regarding perceived and observed effects of co-existing care management services on ability to manage health and coordinate care. The academic health system in which this proposal takes place sits within a regional partnership of health systems. The findings here will be the basis of future work that studies the larger landscape of care management program co-existence across the entire regional partnership. This innovative work addresses how care management programs from multiple sources can co-exist in the care of high need, high cost older adults. Without understanding how programs co-exist, it will be difficult to attribute outcomes to any one intervention, stalling progress towards identifying best practices and improving care for this vulnerable population. The proposed project will support the career development of the candidate, who aims to become an independent clinician investigator focused on identifying best practices to improve care of high need, high cost older adults.