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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.

项目摘要该 K23 奖项将使候选人 Shih-Chuan Chou, MD, MPH, SM 成为一名独立的医生科学家专注于自付费用对急性胸部护理利用和结果的影响疼痛和心血管护理。胸痛是急诊 (ED) 的最常见原因之一评估，每年访问量超过 700 万次。急诊就诊确保及时发现和治疗急性病例心肌梗塞（AMI）或急性冠状动脉综合征（ACS）。然而，护理的财务影响过去二十年来，随着高免赔额健康计划 (HDHP) 的发展，这种情况不断升级。到2020年，近十分之六的拥有雇主赞助保险的美国雇员的免赔额将超过 1,000 美元。尽管研究已经开始探索 HDHP 对癌症筛查和慢性病管理的影响，但很少研究调查了它如何影响急性心血管护理。在初步研究中，周博士发现 HDHP 入组减少了非特异性胸痛的急诊就诊次数，但胸痛入院后 AMI 增加在低收入人群中。在本次 K23 中，周博士将进一步扩展这项研究，提出了 3 项建议目标。目标 1 将在大型商业索赔数据库中使用分段生存分析来检查是否雇主强制的 HDHP 注册对 AMI 结果产生负面影响。使用相同的数据库，目标 2 将利用患者自然随机分配给每个 ED 内的 ED 临床医生来确定 HDHP 是否减少了高入院倾向的临床医生中低价值胸痛入院的情况。最后，目标 3 将包括对患者进行调查和访谈，以了解胸痛情况以及 AMI 患者对急性心肌梗死 (AMI) 患者有多高的看法。零用费用影响他们寻求护理的决定、感知的护理质量以及随后的财务影响。全部目标将进一步关注面临不成比例的经济压力的低收入患者。周博士提出了一个全面的职业发展课程来补充这些目标，包括广泛的教学和体验式学习。周博士组建了一支由具有公认专业知识的跨学科导师团队用于准实验观察研究、保险福利设计、心血管紧急情况、医疗保健差异和急诊医学，他们将为他提供有关这些主题的深入指导。这拟议的研究和职业发展活动将使周博士能够在以下方面建立他的专业知识保险相关政策、护理的经济负担及其对患者使用和结果的影响患有急性心血管疾病。该奖项将使周博士能够转型为独立的临床医生科学家关注高额自付费用的短期和长期影响及其影响围绕急性计划外护理的价格透明度和成本讨论的不断实施访问。完成拟议的研究将产生强有力的证据，以促进对这一问题的理解患者经济负担的临床影响，指导未来有关保险费用分摊政策的法规，以及为急性心血管护理中价格透明度举措的实施提供信息。