Association of Health Care Delivery and Payment Innovations with Avoidable Cardiovascular Hospitalizations

美国心血管疾病（CVD）的年成本估计超过1.2万亿美元， 2035年，CVD住院费用推动了这一估计。[1]尽管预计会有增长，但许多 如果患者接受适当和及时的门诊护理，CVD的住院治疗可能是可以预防的。 医疗保健提供和支付改革可能在削弱预期的利率上升方面发挥的作用 CVD住院治疗和相关费用目前尚不清楚。创新模式的例子 医疗保健提供和支付包括以患者为中心的医疗之家（PCMH），共享储蓄 负责任的医疗组织（ACO），电子病历（EMR）的有意义的使用，以及 区域健康改善合作组织（RHIC）。这四种方法在2008年被广泛采用。 过去十年例如，在2008年至2014年期间，全国医疗网站的数量从 214到6800在俄亥俄州，医疗之家的数量从2008年的零增加到2014年的520个。[2]尽管如此 快速增长，这四种方法对患者结局和护理成本的影响存在不确定性 治疗心血管疾病对于慢性疾病，如心血管疾病，这些方法在早期就证明了 在一系列疾病管理指标上取得成功，例如提供者经验，[3]患者 经验，[3-5]护理过程，[5，6]预防性护理利用，[7]和高成本护理利用。[3]重要的是， 这些范例对潜在可预防的CVD住院的影响的先前研究集中于 每种方法都是单独的，没有涉及相关费用。此外，没有任何先前的研究已经绘制了 这四种方法的医疗保健市场渗透的演变。因此，问题是， 这四种方法在医疗保健市场的渗透率如何影响住院率， CVD的成本仍然没有答案。 本提案的总体目标是解决这一问题，具体目标有两个：首先，量化 以患者为中心的医疗之家的医疗保健市场渗透率，共享储蓄责任护理 组织，区域健康改善协作，以及全州的电子医疗记录 第二，建立CVD住院率变化与 医疗保健市场渗透率的四种方法。成功的模型开发将赋予 决策者就进一步执行和支持综合 医疗保健交付和支付转型模式，这将有助于提高医疗质量和降低成本。

The annual cost of cardiovascular disease (CVD) in the United States is estimated to exceed $1.2 trillion by 2035, with the costs of CVD hospitalizations driving that estimate.[1] Despite this projected growth, many hospitalizations for CVD are potentially preventable if patients receive appropriate and timely ambulatory care. The role that healthcare delivery and payment reform may play in attenuating the expected rise in both the rate of CVD hospitalizations and associated costs is currently unknown. Examples of innovative models of healthcare delivery and payment include the patient centered medical home (PCMH), shared savings accountable care organizations (ACO), meaningful use of electronic medical records (EMR), and the presence of regional health improvement collaboratives (RHIC). These four approaches saw widespread adoption during the last decade. For example, between 2008 and 2014 the number of medical home sites rose nationally from 214 to 6,800. In Ohio, the number of medical home sites rose from zero in 2008 to 520 in 2014.[2] Despite this rapid growth, uncertainty exists about the effect of these four approaches on patient outcomes and cost of care for cardiovascular conditions. For chronic illnesses such as CVD, these approaches demonstrated early successes across a range of disease management indicators such as provider experience,[3] patient experience,[3-5] processes of care,[5, 6] preventive care utilization,[7] and high cost care utilization.[3] Importantly, prior studies of the effects of these paradigms on potentially preventable CVD hospitalization have focused on each approach individually and have not addressed associated costs. Moreover, no prior study has mapped the evolution of the healthcare market penetration of these four approaches. Thus the question of whether and how the growing healthcare market penetration of these four approaches affects the hospitalization rate and costs for CVD remains unanswered. The overall objective of this proposal is to address this question with two specific aims: first, to quantify the healthcare market penetration of patient centered medical homes, shared savings accountable care organizations, regional health improvement collaboratives, and electronic medical records throughout the state of Ohio; second, to model the relationship between changes in the rate of CVD hospitalization and changing healthcare market penetration of each of the four approaches. Successful model development will empower policy makers to make data-driven decisions regarding further implementation and support of integrated models of healthcare delivery and payment transformation that will help improve care quality and reduce costs.