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

项目摘要/摘要 在过去的十年里，美国有130多家乡村医院关闭，加剧了农村地区面临的挑战 社区面临获得保健的问题，并加剧了农村健康差距。宾夕法尼亚州农村卫生局 模式(PARHM)是一种新的替代支付模式(APM)，旨在确保农村地区的财政可行性 医院，增加获得高质量医院服务的机会，改善服务不足的农村人口的健康 社区。PARHM的两个主要组成部分是全球预算和特定于医院的转型 计划。全球预算是由支付者支付的预期付款，以涵盖所有住院和基于医院的 门诊服务。全球预算将医院收入与数量脱钩，目前存在于按 服务支付，从而激励医疗服务的有效利用，并促进减少 可以避免的住院治疗。通过转型计划，医院制定计划，为 满足当地社区的需求。目标是在护理医院的质量上做出有意义的改进 提供并解决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。医院在三年多的时间里加入了帕姆的行列。我们利用变化在 实施PARHM和一个由符合条件但未参加的医院组成的州内对照小组，以 使用差异中的差异设计来比较趋势上的差异，以评估PARHM的效果。我们 提出以下目标：目标1.审查PARHM与乡村医院提供 传统上无利可图的服务线路和患者使用这些服务。我们假设治疗过的医院 将更有可能继续提供对农村地区特别重要的选定医院服务线路 传统上被认为是无利可图的领域(即产科、精神科、药物使用障碍)。 此外，我们假设，与对照组相比，治疗组这些服务的利用率将增加得更多 组。目的2.评估帕尔姆对以下疾病潜在可避免住院率的影响 非卧床护理敏感情况。我们假设，与对照组相比，治疗组的多环芳烃比率将下降更多。 由于加强了非卧床护理协调和财政激励措施，这些群体的健康状况得到了改善。总体而言，这项研究将 解决目前有关帕姆关于健康结果和医院全球预算的文献中的空白 服务线。该项目将为全球预算如何影响就医机会提供新的证据 农村社区的服务和健康结果--对评估帕姆的绩效和 向未来针对NIHMD健康差距社区的支付模式提供信息。本项目竣工 相关的培训目标将为PI提供培训，使其成为一名具有 培训和技能，以批判性地评估和告知服务不足的支付和医疗保健提供政策 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.