Measuring the Clinical and Economic Outcomes Associated with Delivery Systems

 描述(由申请人提供)：本提案围绕交付系统结构、基于PCOR的证据的使用以及相关的临床和经济结果之间的关系进行组织。指导我们提案的核心问题是，循证护理过程的交付以及临床和经济结果的差异是否可以通过可以理解和修改的组织特征来解释，或者这些结果是否是难以转移的组织的“残留”特征。为了解决这个问题，我们设想收集三种类型的数据：从不同角度(包括医院、医生和其他机构提供者)描述卫生系统的“增强型系统数据库”；来自各种数据库的临床数据；以及患者和家庭关于所接受护理质量的自我报告。这些数据将用于五个项目：一个检查全国范围内的交付系统特征和结果；第二个项目侧重于拥有出色数据和多样化医疗需求的四个州(科罗拉多州、缅因州、马萨诸塞州和犹他州)；第三个和第四个项目侧重于那些因缺乏对循证护理的关注而引起许多担忧的特定人群：癌症和儿科；第五个项目研究企业在透析和急性后护理领域整合的原因和后果，这两个行业具有重大的健康后果，但研究较少。该项目的主要产出包括构建新的数据集、关于这些不同主题的研究论文以及向市场参与者和政策制定者传播成果。我们的目标是了解提供系统的哪些特征影响循证护理的传播，以加速卫生系统的质量和价值表现。

 DESCRIPTION (provided by applicant): This proposal is organized around the relationship between delivery system structure, use of PCOR-based evidence, and related clinical and economic outcomes. The central question guiding our proposal is whether differences in the delivery of evidence-based care processes and clinical and economic outcomes can be explained by characteristics of organizations that can be understood and modified, or whether such outcomes are 'residual' characteristics of organizations that are hard to transfer. To address this question, we envision collecting three types of data: an 'enhanced system database' that describes the health system from various perspectives, including hospitals, physicians, and other institutional providers; clinical data from a variety of data bases; and patient and family self-reports about quality of care received. These data will be used in five projects: one examining delivery system characteristics and outcomes nationally; a second focusing on four states with excellent data and diverse health needs (Colorado, Maine, Massachusetts, and Utah); a third and fourth focusing on particular populations where many concerns have been raised about lack of attention to evidence-based care: cancer and pediatrics; and a fifth examining the causes and consequences of corporate integration in dialysis and post-acute care, two industries with major health consequences but which are poorly studied. Major outputs of the project include the construction of new data sets, research papers on these various topics, and disseminating results to market participants and policy makers. Our goal is to learn which features of delivery systems influence the diffusion of evidence-based care, in order to accelerate the quality and value performance of health systems.