Competitive Bidding in Medicare and the Implications for Home Oxygen Therapy in COPD

医疗保险竞争性招标以及对慢性阻塞性肺病家庭氧疗的影响

• 批准号: 10641360
• 负责人: Kevin Duan
• 金额: $ 18.86万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-26 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641360
• 关键词: Accounting; Address; Affect; American; American Lung Association; Area; Award; Caring; Cause of Death; Cessation of life; Chest; Chronic; Chronic Obstructive Pulmonary Disease; Clinic; Clinical; Clinical Investigator; Competitive Bidding; Contracts; Data Set; Development Plans; Diabetes Mellitus; Disease Outcome; Durable Medical Equipment; Environment; Equipment; Foundations; Future; Geographic Locations; Geography; Goals; Grant; Health; Health Policy; Health system; Healthcare Systems; Home; Hospitalization; Inpatients; Interview; Knowledge; Life; Measures; Medicare; Medicare claim; Mentors; Methodology; Methods; Monitor; Morbidity - disease rate; Nurses; Outcome; Oxygen; Oxygen Therapy Care; Participant; Patient Care; Patient Preferences; Patient-Focused Outcomes; Patients; Physicians; Policies; Policy Research; Population; Population Study; Price; Probability; Process; Professional Organizations; Provider; Public Health; Qualitative Research; Quasi-experiment; Research; Research Activity; Research Methodology; Research Personnel; Research Training; Respiratory Disease; Sampling; Services; Societies; Structure; System; Testing; Training; Training Activity; United States; United States Department of Veterans Affairs; Universities; Voice; Washington; beneficiary; burden of illness; career; career development; clinical center; cost; design; experience; improved; innovation; insight; medical schools; mortality; negative affect; patient oriented; payment; primary outcome; programs; respiratory; respiratory health; secondary outcome; sound

PROJECT SUMMARY/ABSTRACT Chronic obstructive pulmonary disease (COPD) causes the largest burden of disease among chronic respiratory conditions in the United States, affecting 16 million Americans and leading to 150,000 deaths annually. Home oxygen therapy is one of few therapies in COPD that reduces mortality. Over the last decade, a Medicare policy, the Competitive Bidding Program (CBP), has significantly changed the price of home oxygen and the number of suppliers servicing patients. The effect of this policy has not been studied extensively and is currently unknown. Professional societies have voiced concern that patient access to home oxygen and its associated clinical benefits have been negatively affected. On the other hand, program monitoring by Medicare has not revealed any unintended consequences of the CBP. This mixed methods study proposes to use quasi-experimental observational methods and semi-structured qualitative interviews to independently and rigorously evaluate the effects of the CBP on home oxygen access and clinical outcomes among patients with COPD. Dr. Duan will (1) assess the effect of the CBP on access to home oxygen among patients with COPD, (2) examine the association between the CBP and patient-centered clinical outcomes among patients with COPD, and (3) identify patient and provider perspectives about their current experience with home oxygen prescribing. This proposal will generate important policy and patient care insights that have the potential to inform CBP redesign and lay the foundation for future strategies to improve home oxygen care. Through this grant, Dr. Duan, an early career investigator and pulmonologist, will receive training in advanced causal inference methods, the analysis of large administrative datasets for policy research, and qualitative research methods. The proposed research and comprehensive career development plan will prepare Dr. Duan for a career as an independent investigator studying how health systems and policies can be optimized to improve respiratory health and value for patients. These research and training activities will be supervised by an expert team of mentors at the academically rich research environments of the University of Washington Schools of Medicine and Public Health, as well as the Department of Veterans Affairs Puget Sound Health Care System.

项目总结/摘要 慢性阻塞性肺疾病（COPD）是慢性阻塞性肺疾病中最大的疾病负担。 美国的呼吸系统疾病，影响了1600万美国人，导致15万人死亡 每年。家庭氧疗是COPD中少数几种降低死亡率的疗法之一。在过去的十年里， 医疗保险政策--竞标计划（CBP）--显着改变了房价 氧气和为病人服务的供应商的数量。这项政策的效果还没有研究过 广泛存在，目前未知。专业协会表示担心， 氧气及其相关的临床益处受到负面影响。另一方面，方案 医疗保险的监测没有显示CBP的任何意外后果。 本混合方法研究建议使用准实验观察方法和半结构化 定性访谈，以独立和严格地评估CBP对家庭氧气获取的影响 和COPD患者的临床结局。Duan博士将（1）评估CBP对获得 COPD患者的家庭氧疗，（2）检查CBP与以患者为中心的 COPD患者的临床结果，以及（3）确定患者和提供者对他们的观点， 目前的经验与家庭氧气处方。这项提案将产生重要的政策和病人护理 这些见解有可能为CBP的重新设计提供信息，并为未来的改进战略奠定基础。 家庭氧气护理 通过这笔赠款，段博士，一个早期的职业调查员和肺病学家，将接受高级培训， 因果推理方法，政策研究的大型行政数据集的分析，以及定性 研究方法建议的研究和全面的职业发展计划将为段博士做好准备 作为一名独立调查员，研究如何优化卫生系统和政策， 改善患者呼吸系统健康和价值。这些研究和培训活动将由下列人员监督： 华盛顿大学学术研究环境丰富， 医学院和公共卫生学院，以及退伍军人事务部普吉特湾健康 护理系统。