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

• 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
• 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

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 这个K23奖将使候选人，周世全，医学博士，公共卫生硕士，SM，成为一个独立的 医生-科学家关注自付费用对急性胸部疾病的护理利用和结局的影响 疼痛和心血管护理。胸痛是急诊科（艾德）最常见的原因之一 每年访问量超过700万次。艾德访视确保及时识别和治疗急性 心肌梗死（AMI）或急性冠状动脉综合征（ACS）。然而，护理的财务影响 在过去的二十年里，随着高免赔额健康计划（HDHP）的增长，到2020年， 近60%的美国雇员拥有雇主赞助的保险，免赔额将≥ 1000美元。而 研究已经开始探索HDHP对癌症筛查和慢性病管理的影响， 研究已经检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艾德访视，但增加了胸痛入院后的AMI 在低收入人群中。在K23中，Chou博士将进一步扩展这项研究，提出3项建议 目标。Aim 1将在一个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入组对AMI结局产生了负面影响。使用相同的数据库，aim 2 将在每个艾德内利用患者自然随机分配至艾德临床医生，以确定HDHP是否 减少了高入院倾向的临床医生中的低价值胸痛入院。最后，目标3将 包括患者调查和访谈，以了解胸痛和AMI患者对 自付费用影响他们寻求护理的决定、感知的护理质量和随后的财务影响。所有 aims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，以补充这些目标，包括广泛的教学和 体验式学习周博士组建了一个跨学科的导师团队， 在准实验性观察研究中，保险福利设计，心血管急症，医疗保健 差异，和急诊医学，谁将为他提供这些主题的密集指导。的 拟议的研究和职业发展活动将使周博士建立他的专业知识， 与保险相关的政策、医疗的经济负担及其对患者使用和结局的影响 急性心血管疾病这一奖项将使周博士过渡到一个独立的 临床科学家，专注于高自付成本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日益实施 探访完成拟议的研究将产生强有力的证据，以促进对 患者经济负担的临床影响，指导未来围绕保险费用分摊政策的法规，以及 为实施急性心血管护理的价格透明度举措提供信息。