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

针对高需求、高成本老年人的护理管理计划共存的特征和效果

• 批准号: 9751153
• 负责人: Stephanie Nothelle
• 金额: $ 12.28万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751153
• 关键词: Acute; Address; Administrator; Adult; Adverse event; Ambulatory Care; Ambulatory Care Facilities; Area; Baltimore; Caring; Case Manager; Characteristics; Clinical; Clinics and Hospitals; Collaborations; Community Health; Complex; Conflict (Psychology); Continuity of Patient Care; Data; Data Analyses; Development; Dimensions; Disease Management; Elderly; Enrollment; Environment; Evaluation; Fostering; Future; Goals; Health; Health care facility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Impaired cognition; Individual; Institution; Intervention; Interview; Light; Link; Medication Errors; Medicine; Mentored Patient-Oriented Research Career Development Award; Nature; Outcome; Participant; Patients; Policies; Policy Maker; Population; Population Sizes; Primary Health Care; Provider; Research; Research Personnel; Resources; Risk; Services; Source; Structure; Surveys; System; Time; Treatment Protocols; United States; United States National Institutes of Health; Vulnerable Populations; Work; base; care coordination; care outcomes; career; career development; cost; cost outcomes; experience; functional disability; health care service; health care service utilization; health management; health plan; human old age (65+); improved; improved outcome; innovation; inpatient service; interest; medical specialties; multiple chronic conditions; patient home care; payment; population health; programs; recruit; service coordination; service delivery

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.

一小部分人口占医疗保健支出的大部分。这些人 65岁以上的成年人经常使用卫生保健服务， 多种慢性疾病和/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，因可预防的疾病住院，实验室和药物错误， 对他们的照顾感到不满。护理管理计划可能是一个很有前途的方法， 人口卫生保健环境的变化导致了这些项目的激增;估计 这表明，目前存在的护理管理计划是10年前的3倍。许多这些 目前在独立的实体内开发了一些项目，如门诊诊所、急诊医院、 和负责任的护理组织，传统上不合作;这意味着，不止一个计划可能 不知不觉地试图管理一个人的照顾。目前尚不清楚护理管理计划 共同存在于高需求、高成本的老年人群体中。该提案旨在填补这一重要 通过评估护理管理方案共存的范围、性质和效果， 高需要高成本的老年人。目标1侧重于从一些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。对项目管理人员进行结构化调查， 特色这些项目中入组患者的数据将与 汇总医疗服务利用数据，以检查人口规模、人口统计学和临床特征 高需求，高成本的老年人谁是登记在共存的护理管理计划。目的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， 高需求、高成本的老年人和一线计划工作人员的观点（即-案例经理）关于 感知和观察到的共存护理管理服务对管理健康和 协调护理。这一建议所处的学术卫生系统位于一个区域内， 卫生系统伙伴关系。这里的发现将是未来研究更大的 在整个区域合作伙伴关系中共同存在护理管理方案的前景。这一创新 工作解决了如何从多个来源的护理管理程序可以共存于高需求的护理， 高成本的老年人。如果不了解方案如何共存，就很难将结果归因于 任何一项干预措施，阻碍了在确定最佳做法和改善对这一弱势群体的护理方面取得进展。 人口拟议的项目将支持候选人的职业发展，目标是成为 一名独立的临床研究人员专注于确定最佳实践，以改善高需求，高 花费老年人。