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Impact of Health Deductible Health Plans on the Evaluation, Treatment, and Outcomes for Acute Coronary Syndrome

健康免赔额健康计划对急性冠脉综合征评估、治疗和结果的影响

基本信息

批准号：
10663659
负责人：
Shih-Chuan Chou
金额：
$ 16.99万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-09 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10663659
关键词：
Accident and Emergency department Active Learning Acute Acute myocardial infarction Adherence Admission activity Affect Award Behavior Cardiac Cardiovascular Diseases Cardiovascular system Caring Chest Pain Chronic Disease Clinical Complement Cost Sharing Cost-Sharing Insurance Data Databases Deductibles Disease Management Disease Outcome Elements Emergency Care Emergency Department evaluation Emergency Department patient Emergency Medicine Emergency Situation Emergency department visit Employee Enrollment Ensure Evaluation Face Financial Hardship Funding Future Goals Grant Growth Health Health Care Costs Health Insurance Healthcare Heart Diseases High Prevalence Hospitalization Image Incentives Inpatients Insurance Insurance Benefits Insurance Carriers Interview Ischemia Low Income Population Low income Measures Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Myocardial Infarction Natural experiment Observational Study Outcome Patient-Focused Outcomes Patients Perception Physicians Policies Price Qualitative Research Quality of Care Quasi-experiment Randomized Regulation Research Research Design Research Methodology Research Personnel Role Scientist Screening for cancer Severities Surveys Survival Analysis Testing Training Variant Visit Work Writing acute care acute coronary syndrome cardiovascular emergency care burden care outcomes care seeking career career development cost curriculum development design empowerment experience health care disparity health plan health savings account hospital readmission insight insurance claims interest member policy recommendation preservation research and development shared decision making

项目摘要

PROJECT ABSTRACT This K23 award will enable the candidate, Shih-Chuan Chou, MD, MPH, SM, to become an independent physician-scientist focused on the effect of out-of-pocket costs on care utilization and outcomes of acute chest pain and cardiovascular care. Chest pain is one of the most common reasons for emergency department (ED) evaluation, with over 7 million visits annually. ED visits ensure the timely identification and treatment of acute myocardial infarction (AMI) or acute coronary syndrome (ACS). However, the financial implications of care have escalated over the past two decades with the growth of high deductible health plans (HDHP). By 2020, nearly 6 in 10 US employees with employer-sponsored insurance will have deductibles of ≥$1,000. While research has begun to explore HDHP’s effect on cancer screening and chronic disease management, little research has examined how it affects acute cardiovascular care. In a preliminary study, Dr. Chou found that HDHP enrollment reduced ED visits for non-specific chest pain but increased AMI after chest pain admission among the lower-income population. In this K23, Dr. Chou will further extend this research with 3 proposed aims. Aim 1 will use segmented survival analysis in a large commercial claims database to examine whether employer-mandated HDHP enrollment negatively impacted AMI outcomes. Using the same database, aim 2 will utilize the natural randomization of patients to ED clinicians within each ED to determine whether HDHP reduces low-value chest pain admissions among clinicians with high admitting tendencies. Lastly, aim 3 will include patient surveys and interviews to elicit chest pain and AMI patients’ perspectives on how high out-of- pocket costs affected their decisions to seek care, perceived care quality, and subsequent financial impact. All aims will further focus on low-income patients that face disproportionate financial stress. Dr. Chou proposed a comprehensive career development curriculum to complement these aims, consisting of extensive didactic and experiential learning. Dr. Chou has assembled an interdisciplinary team of mentors with recognized expertise in quasi-experimental observational studies, insurance benefit design, cardiovascular emergencies, health care disparities, and emergency medicine, who will provide him with intensive mentorship in these topics. The proposed research and career development activities will allow Dr. Chou to establish his expertise in insurance-related policies, the financial burden of care, and their impact on the use and outcomes of patients with acute cardiovascular conditions. This award will enable Dr. Chou to transition into an independent clinician-scientist focusing on the short- and long-term impact of high out-of-pocket costs and the implications around the growing implementation of price transparency and cost discussions for acute unscheduled care visits. Completing the proposed research will generate robust evidence to advance the understanding of the clinical impact of patient financial burden, guide future regulations around insurance cost-sharing policies, and inform the implementation of price transparency initiatives in acute cardiovascular care.

项目摘要