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 不成比例的可能是 65 岁以上的成年人，他们经常使用医疗保健服务，因为 多种慢性病和/或功能障碍。这些“高需求、高成本”的老年人更 可能会经历分散的护理、因可预防的情况而住院、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个有前途的方法 人口。医疗保健环境的变化导致了这些项目的激增；估计 表明目前存在的护理管理项目数量是 10 年前的 3 倍。其中许多 目前，项目是在门诊诊所、急症护理医院等独立实体内开发的 以及传统上不合作的责任医疗组织；也就是说，可能有多个程序 不知不觉地试图管理单个人的护理。目前尚不清楚护理管理计划如何 共存于高需求、高成本老年人口的护理中。本提案旨在填补这一重要空白 通过评估护理管理计划共存的范围、性质和效果来弥补差距，这些计划的目标是 高需求、高成本的老年人。目标 1 重点关注多个潜在的护理管理计划 资源（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。计划管理员的结构化调查将评估计划 特征。这些项目中登记患者的数据将进行交叉匹配并与 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 参加共存护理管理计划的高需求、高成本老年人。目标2 通过进行深入访谈和定性数据分析来扩展目标 1 的发现，以探索 高需求、高成本的老年人和一线项目工作人员（即个案经理）对以下方面的看法 共存护理管理服务对健康管理能力的感知和观察到的影响 协调护理。本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范围的工作的基础 护理管理计划在整个区域伙伴关系中共存。这种创新的 工作解决了来自多个来源的护理管理计划如何在高需求护理中共存， 高成本的老年人。如果不了解程序如何共存，就很难将结果归因于 任何一项干预措施都会阻碍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 一位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、高需求的护理 花费老年人。