Measuring the Clinical and Economic Outcomes Associated with Delivery Systems

 描述（由申请人提供）：本提案围绕输送系统结构、使用基于PCOR的证据以及相关临床和经济结局之间的关系进行组织。指导我们的建议的中心问题是，是否可以通过可以理解和修改的组织特征来解释循证护理过程和临床及经济结果的差异，或者这些结果是否是难以转移的组织的“剩余”特征。为了解决这个问题，我们设想收集三种类型的数据：一个“增强系统数据库”，从不同的角度描述卫生系统，包括医院，医生和其他机构提供者;临床数据从各种数据库;和病人和家庭自我报告的质量得到的护理。这些数据将用于五个项目：一个项目检查全国的交付系统特征和结果;第二个项目侧重于四个具有良好数据和不同卫生需求的州（科罗拉多、缅因州、马萨诸塞州和犹他州）;第三和第四个重点关注特定人群，他们对缺乏循证护理的关注度提出了许多担忧：癌症和儿科;第五篇研究透析和急性期后护理的企业整合的原因和后果，这两个行业对健康有重大影响，但研究很少。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决策者传播结果。我们的目标是了解提供系统的哪些功能会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.