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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.

项目总结/文摘