Impacts of the Pennsylvania Rural Health Model on Health Care Access and Utilization

项目总结/摘要 在过去十年中，美国有130多家农村医院关闭，加剧了农村地区面临的挑战。 社区面临获得保健的问题，并加剧了农村的保健差距。宾夕法尼亚州农村健康 PARHM模型是一种新的替代支付模型，旨在确保农村金融的可行性。 医院，增加获得高质量医院服务的机会，并改善服务不足的农村人口的健康状况 社区. PARHM的两个主要组成部分是全球预算和医院特定转型 布局全球预算是支付方为覆盖所有住院和住院患者而支付的预期款项。 门诊服务。全球预算将医院收入与数量脱钩，目前存在的情况是， 服务支付，从而激励有效利用医疗服务，促进减少 可避免的住院治疗。通过转型计划，医院制定计划， 当地社区的需要。目标是对护理医院的质量进行有意义的改进 提供和解决其社区最迫切的卫生需求，以改善人口健康， 实现未来储蓄。医院在三年内加入了PARHM的队列。我们利用变化， PARHM的实施和州内合格但未参与医院的对照组， 使用差异中差异设计评价PARHM的效果，以比较趋势差异。我们 提出以下目标：目标1。审查PARHM与农村医院提供的 传统上无利可图的服务线和患者对这些服务的使用。我们假设治疗医院 将更有可能继续提供对农村地区特别重要的选定的医院服务项目， 传统上被认为是无利可图的领域（即，产科、精神科、物质使用障碍）。 此外，我们假设治疗组与对照组相比，这些服务的利用率将增加更多 组目标2.评估PARHM对潜在可避免的住院率（PAH）的影响， 门诊护理敏感条件。我们假设治疗组与对照组相比，PAH发生率降低更多 由于改善了门诊护理协调和财政激励措施，总的来说，这项研究将 解决目前文献中关于PARHM在健康结果和全球医院预算方面的差距 服务线。该项目将提供有关全球预算如何影响就医的新证据 农村社区的服务和卫生成果-对评估PARHM的业绩至关重要， 为NIHMD健康差异社区提供未来的支付模式。完成本项目 相关的培训目标将为PI提供培训，使其成为具有以下能力的医生-科学家： 培训和技能，以批判性地评估和告知支付和医疗保健提供政策，为服务不足 在美国的社区。

PROJECT SUMMARY/ABSTRACT More than 130 rural hospitals in the U.S. have closed over the past decade, exacerbating challenges that rural communities face accessing care and contributing to rural health disparities. The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model (APM) intended to ensure the financial viability of rural hospitals, increase access to high-quality hospital services, and improve population health in underserved rural communities. The two main components of PARHM are global budgets and hospital-specific transformation plans. Global budgets are prospective payments made by payers to cover all inpatient and hospital-based outpatient services. Global budgets decouple hospital revenue from volume, as currently exists under fee-for- service payment, and therefore incentivize the efficient use of medical services and promote reduction of avoidable hospitalizations. Through transformation plans, hospitals develop plans to tailor services to the needs of the local community. The goal is to make meaningful improvements in the quality of the care hospitals provide and address the most pressing health needs in their communities to improve population health and realize future savings. Hospitals joined PARHM in cohorts over three years. We leverage variation in implementation of PARHM and a within-state control group of eligible but non-participating hospitals to evaluate the effects of PARHM using a difference-in-differences design to compare differences in trends. We propose the following aims: Aim 1. Examine the association of PARHM with rural hospitals’ provision of traditionally unprofitable service lines and patient use of those services. We hypothesize that treated hospitals will be more likely to continue offering selected hospital service lines that are of particular significance to rural areas and have traditionally been considered unprofitable (i.e., obstetrics, psychiatric, substance use disorder). Furthermore, we hypothesize that utilization rates for these services will increase more in treated vs. control groups. Aim 2. Assess the impact of PARHM on rates of potentially avoidable hospitalizations (PAHs) for ambulatory care sensitive conditions. We hypothesize that PAH rates will decrease more in treated vs. control groups as a result of improved ambulatory care coordination and financial incentives. Overall, this study will address the current gap in the literature regarding PARHM on health outcomes and global budgets on hospital service lines. This project will provide novel evidence about how global budgets affect access to hospital services and health outcomes in rural communities—critical for evaluating PARHM’s performance and informing future payment models targeted to NIHMD health disparities communities. Completion of this project and the associated training goals will provide the PI with training to become a physician-scientist with the training and skills to critically evaluate and inform payment and health care delivery policy for underserved communities in the United States.