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

基本信息

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
项目类别：
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

项目摘要

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。这些人超过65岁的成年人通常是医疗服务的使用者到多种慢性病和/或功能障碍。这些“高需求，高成本”的老年人更多可能会体验零散的护理，可预防状况的住院，实验室和药物错误，和对他们的关怀不满意。护理管理计划可能是一种有前途的方法人口。医疗保健环境的变化导致这些计划的扩散。估计表明，今天的护理管理计划与10年前一样。其中许多计划目前是在门诊诊所，急诊医院等独立实体内开发的传统上不合作的责任心组织；意思是，一个以上的程序可能未知试图管理一个人的护理。目前尚不清楚如何护理管理计划共存高需求，高成本的老年人。该建议旨在填补这一重要的通过评估针对护理管理计划的共存的范围，性质和影响的差距高成本的老年人需要高成本。 AIM 1专注于许多潜力的护理管理计划来源（健康计划，主要和专业门诊护理，急性住院护理以及家庭护理）大型学术卫生系统。计划管理员的结构化调查将评估计划特征。这些计划中有关患者的注册患者的数据将是交叉匹配的，并与汇总医疗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，成本高昂的老年人参加了共存的护理管理计划。目标2 通过进行深入的访谈和定性数据分析来探索AIM 1的发现。高需求，高成本老年人和前线计划人员（即 - 案例经理）的观点共存的护理管理服务对管理健康的能力的影响和观察到的影响协调护理。该提案发生的学术卫生系统位于一个地区卫生系统的合作伙伴关系。这里的发现将是研究较大的未来工作的基础整个区域伙伴关系的护理管理计划的景观共存。这种创新工作解决了来自多个来源的护理管理计划如何在照顾高需求的情况下共存，高成本的老年人。在不了解程序如何共存的情况下，很难将结果归因于任何一项干预措施，在确定最佳实践并改善对此脆弱的护理方面的上台进展人口。拟议的项目将支持候选人的职业发展，他们旨在成为一个独立的临床研究者，致力于确定最佳实践以提高对高需求的护理老年人成本。