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

宾夕法尼亚州农村卫生模式对医疗保健获取和利用的影响

基本信息

批准号：
10818023
负责人：
Donald Spencer Bourne
金额：
$ 5.27万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
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：
2023-11-01 至 2025-10-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10818023
关键词：
Address Affect Ambulatory Care Budgets Caring Clinical Medicine Communities Community Health Compensation Control Groups Data Discipline of obstetrics Disincentive Disparity Eligibility Determination Ensure Equity Face Fee-for-Service Plans Future Goals Health Health Policy Health Service Area Health Services Accessibility Healthcare Hospitalization Hospitals Improve Access Incentives Individual Inpatients Intervention Literature Maryland Medical Mentors Methods Modeling National Institute on Minority Health and Health Disparities Outcome Outcome Assessment Patient-Focused Outcomes Patients Pennsylvania Performance Phase Physicians Policies Policy Research Psychiatry Publishing Quality of Care Research Running Rural Rural Community Rural Health Rural Hospitals Rural Population Savings Scientist Service provision Services Substance Use Disorder System Time Training United States United States Centers for Medicare and Medicaid Services Variant biomedical referral center care coordination care outcomes career cohort cost critical access hospital design econometrics experience experimental group experimental study financial incentive future implementation health care availability health care delivery health care disparity health care service utilization health disparity populations health equity hospital care hospital services hospitalization rates improved innovation lens mortality multidisciplinary novel outpatient programs payment poor health outcome population health programs prospective response rural area rural health disparities rural healthcare rural patients rural setting rural underserved service utilization skills substance abuse treatment success trend underserved community urban disparity

项目摘要

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.

项目摘要/摘要在过去的十年中，美国有130多家农村医院已关闭，加剧了农村的挑战社区面临着护理和造成粗糙健康差异的贡献。宾夕法尼亚农村健康模型（PARHM）是一种新颖的替代支付模型（APM），旨在确保农村的财务可行性医院，增加获得高质量医院服务的机会，并改善服务不足的农村的人口健康社区。 PARHM的两个主要组成部分是全球预算和特定医院的转型计划。全球预算是付款人的潜在付款，以覆盖所有住院和医院门诊服务。全球预算将医院的收入从数量中删除，目前存在于收费下服务支付，因此激励有效地使用医疗服务并促进减少可避免住院。通过转型计划，医院制定了计划，以量身定制服务当地社区的需求。目的是改善护理医院的质量提供并满足其社区中最紧迫的健康需求，以改善人口健康和实现未来的节省。医院在三年内加入了Parhm。我们利用实施PARHM和一个国家内部的对照组，包括合格但无参与的医院使用差异差异设计来评估PARM的效果，以比较趋势的差异。我们提案以下目的：目标1。检查帕尔姆与农村医院的协会传统上，服务线和患者对这些服务的使用。我们假设接受治疗的医院更有可能继续提供所选的医院服务线，这对常规领域，传统上被认为是无利可图的（即妇产科，精神病，药物使用障碍）。此外，我们假设这些服务的利用率将在治疗和控制中增加更多组。 AIM 2。评估Parhm对可能避免住院率（PAH）的影响门诊护理敏感条件。我们假设PAH率在处理过的对照中会降低。由于改善了门诊护理协调和经济激励措施，团体。总体而言，这项研究将解决有关PARHM关于健康成果和全球预算医院的当前差距服务线。该项目将提供有关全球预算如何影响住院的新颖证据农村社区的服务和健康成果 - 评估Parhm的绩效和告知针对NIHMD健康差异社区的未来付款模式。该项目的完成相关的培训目标将为PI提供培训，以成为一名身体科学家培训和技能，以批判性评估和告知付款和医疗保健提供政策美国的社区。