Measuring the Value of Improving Access to Community Care

衡量改善社区护理服务的价值

• 批准号: 10847381
• 负责人: Edwin S. Wong
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10847381
• 关键词: Address; Appointment; Area; Budgets; Businesses; Cardiology; Caring; Characteristics; Communities; Community Care Networks; Community Healthcare; Community Networks; Contracts; Data; Data Linkages; Degree program; Development; Dimensions; Econometric Models; Eligibility Determination; Ensure; Evaluation; Facilities and Administrative Costs; Future; Geographic Locations; Goals; Health Policy; Health Services Accessibility; Health care facility; Healthcare; Healthcare Systems; Heterogeneity; Improve Access; Individual; Learning; Light; Literature; Location; Logit Models; Marketing; Measurement; Measures; Medical; Methodology; Methods; Modeling; Observational Study; Office Management; Outpatients; Parameter Estimation; Patient Preferences; Patient Selection; Patients; Perception; Performance; Policies; Policy Maker; Primary Care; Provider; Quality of Care; Recommendation; Relaxation; Role; Science; Specific qualifier value; Statutes and Laws; Strategic Planning; Time; Travel; United States; Validation; Veterans; Wait Time; care systems; cost; design; econometrics; economic value; health assessment; health care availability; health care quality; health care service; health economics; improved; innovation; interest; medical specialties; novel; opportunity cost; outpatient programs; preference; programs; simulation; stem; tool; willingness to pay

Background: Providing timely access to health care has been a long-standing VA goal that has been re- emphasized by the Commission on Care. To improve access to care, VA implemented the Veterans Choice Program in August 2014, which provides eligible Veterans the option of receiving care from community providers paid for by VA. Currently, there is a substantial gap in scientific evidence on the effect of the Choice Program and other VA community care programs, particularly in regards to the degree the program has improved access to care. More generally, non-VA literature examining the effect of greater provider options has focused on changes in utilization, but has not assessed the value of improved patient choice. The development of measures that capture the value of greater provider options is methodologically challenging because patients’ preferences are not directly observed and value encompasses many dimensions of access (e.g., travel distance, appointment wait times, provider quality, etc.). To address these evidence gaps, we propose the development and examination of new measures capturing the value of provider options to Veterans using state-of-the art econometric methods. Greater scientific evidence to help VA provide enhanced choice for Veterans through the Choice Program and future VA community care programs is consistent with the VHA FY 2018-2019 Operational Plan. This study addresses the ORD-wide Learning Health Care System priority area and HSR&D’s Access and Health Care Systems Change major priority domains. Objectives: The objectives of this study are to: 1) develop new econometric method applications to quantitatively measure the value of greater access to providers from the perspective of Veterans and 2) examine the relative importance of local area and provider characteristics in determining Veterans’ value of having improved access to providers. Methods: This observational study will examine VA administrative data and existing public data characterizing outpatient providers. In Aim 1, we will use VA administrative data to identify: 1) Veterans eligible for the VA Choice Program in 2016, 2) VA and Choice outpatient providers and 3) utilization of outpatient services from VA facilities and through the Choice Program. We will analyze Veterans’ revealed preference for providers using econometric random utility models. These models assume patients select the provider that yields the greatest benefit, given all available options. We will empirically estimate Veterans’ choice of provider within the random utility framework using a nested multinomial logit model (NMNL). We will then use parameter estimates and predictive margins from the NMNL model to calculate the value of greater provider options through the Choice Program. Specifically, econometric models will calculate Veterans’ willingness to pay (WTP), which represents the maximum dollar amount an individual would theoretically pay for greater provider options. In Aim 2, we will apply econometric decomposition methods to models developed in Aim 1 to assess the influence of key provider and local area characteristics in determining value. Notably, we will leverage novel data linkages between VA administrative data and public use data capturing an extensive set of provider characteristics. Statement on Next Steps: We will develop a simulation tool designed for non-researchers that incorporates study results to estimate the value to Veterans of a specified set of provider options (i.e. a community care network). This tool will provide the ability for operational partners to assess the adequacy of community care networks and establish the business case of “what-if” scenarios. Stakeholders will be able to adapt to changing conditions through simulating the hypothetical addition and subtraction of providers within a community care network. This simulation feature will facilitate future analyses to ensure community care networks include high quality providers that best match Veterans’ preferences.

背景：提供及时的医疗保健一直是退伍军人事务部的一个长期目标， 这是护理委员会强调的。为了改善获得护理的机会，VA实施了退伍军人选择 2014年8月的计划，为符合条件的退伍军人提供从社区接受护理的选择 由VA支付的供应商。目前，关于选择的影响，科学证据存在很大差距 计划和其他VA社区护理计划，特别是在该计划的程度方面， 改善获得护理的机会。更一般地说，非VA文献研究了更多供应商选择的影响， 关注的是利用率的变化，但没有评估改善患者选择的价值。的 开发能够捕捉更多供应商选择的价值的度量方法在方法上具有挑战性 因为患者的偏好无法直接观察到，价值包含了访问的许多方面， (e.g.,行进距离、预约等待时间、提供者质量等）。为了弥补这些证据不足，我们 建议制定和审查新的衡量标准，以体现供应商选择的价值， 使用最先进的计量经济学方法的退伍军人。更多的科学证据帮助VA提供增强的 通过选择计划和未来的VA社区护理计划为退伍军人提供的选择是一致的 VHA FY 2018-2019运营计划。本研究探讨了整个职业发展署的学习保健系统 优先领域和HSR&D的访问和医疗保健系统改变主要优先领域。 目的：本研究的目的是：1）开发新的计量经济学方法的应用， 从退伍军人的角度定量衡量更多获得供应商的价值，2） 检查在确定退伍军人的价值，当地和供应商的特点的相对重要性， 改善了与供应商的接触。 方法：这项观察性研究将检查VA管理数据和现有的公共数据， 门诊提供者。在目标1中，我们将使用VA管理数据来确定：1）符合VA条件的退伍军人 2016年选择计划，2）VA和选择门诊提供者，3）门诊服务的利用率， VA设施和通过选择方案。我们将分析退伍军人对供应商的偏好 使用计量经济学随机效用模型。这些模型假设患者选择提供者， 最大的好处，考虑到所有可用的选项。我们将根据经验估计退伍军人在 随机效用框架使用嵌套多项logit模型（NMNL）。我们将使用参数 NMNL模型的估计和预测利润，以计算更大供应商选项的价值 通过选择方案。具体来说，计量经济学模型将计算退伍军人的支付意愿， (WTP)，这代表了理论上个人为更大的供应商支付的最高美元金额 选项.在目标2中，我们将对目标1中开发的模型应用计量经济学分解方法， 关键供应商和当地特征在确定价值方面的影响。值得注意的是，我们将利用 VA行政数据和公共使用数据之间的新型数据链接， 特色 关于下一步的声明：我们将开发一个为非研究人员设计的模拟工具， 研究结果，以估计一组指定的提供者选项（即社区护理）对退伍军人的价值 网络）。这一工具将使业务伙伴能够评估社区护理的充分性 网络，并建立“假设”方案的业务案例。利益相关者将能够适应变化 通过模拟社区护理中提供者的假设增加和减少， 网络这一模拟功能将有助于未来的分析，以确保社区护理网络包括高 最符合退伍军人偏好的优质供应商。

项目成果

How Did Veterans' Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?

• DOI: 10.1097/mlr.0000000000001764
• 发表时间: 2022-10-01
• 期刊: MEDICAL CARE
• 影响因子: 3
• 作者: Sterling, Ryan A.;Liu, Chuan-Fen;Wong, Edwin S.
• 通讯作者: Wong, Edwin S.