The Effect of Value-based Payment on Heart Failure Quality of Care (Value-HF)

项目摘要/摘要 心力衰竭每年导致超过8万人死亡，花费300亿美元，但改善的治疗方法 生存和降低发病率没有得到充分利用。医疗质量不足和成本过高引发了 开发基于价值的支付计划，例如Medicare的基于功绩的激励计划(MIPS)。 MIPS是美国使用的最大的临床医生价值支付计划。MIPS旨在 通过根据临床医生的表现更改临床医生的报酬，在降低成本的同时提高护理质量 关于成本和质量的措施。MIPS质量测量越来越关注患者报告的结果 (PRO)措施，包括心力衰竭，尽管有有限的证据表明PRO可以改善心力衰竭的护理。目标 1将是一项务实的单中心随机试验，评估PRO评估是否整合到 常规心力衰竭临床工作流程是可行的，并在一年内改善了与健康相关的生活质量。这 以患者为中心的试验将确定PRO评估的临床影响是否值得数据成本 收集。AIM 2将评估引入MIPS(2017年)与 医疗保险心力衰竭护理：指南推荐的治疗用法、死亡率和成本。这项研究将使用 开发多种分析方法和对照(退伍军人和商业保险的心力衰竭患者) 对这些关联的可靠估计。这项工作将对心力衰竭的临床护理产生实质性的影响 通过定义常规PRO评估和MIPS作为一个整体的效果来评估患者的预后。会的 告知未来临床医生基于价值的付费模式的设计。桑杜博士将利用这项研究和 这个K23奖项的受保护的时间、培训和指导，使其成为一个独立的、以患者为导向的 卫生服务研究员。桑杜博士的长期研究目标是提高产品的质量和效率 通过评估地方质量改进和全民健康的实施情况来护理心力衰竭患者 政策。建议的研究经验和在临床试验和因果推断统计方面的培训 在这个奖项期间是实现这些目标的关键。他将通过当地的课程学习获得这些技能 研究研讨会、全国会议，以及他的指导团队的直接指导。他的导师是 实施试验、结果分析和高级统计方法方面的专家。它们是补充的 拥有一个出色的咨询委员会，在临床试验、心力衰竭和健康方面具有互补的专业知识 政策。在这个指导团队和斯坦福大学医学部的支持下，桑杜医生将拥有 有效完成AIM 1试验的工具。他严格的训练计划，他导师的专业知识，以及 他在数据方面的经验使目标2中复杂的政策分析变得可行。总体而言，培训， 该奖项的研究和指导将指导桑杜博士过渡到独立的、 成功的以患者为导向的健康服务研究人员，具备竞争R级资金的技能。

PROJECT SUMMARY/ABSTRACT Heart failure causes over 80,000 deaths and $30 billion in spending annually, yet therapies that improve survival and reduce morbidity are underutilized. Insufficient healthcare quality and high costs sparked the development of value-based payment programs, such as Medicare’s Merit-based Incentive Program (MIPS). MIPS is the largest clinician value-based payment program in use in the United States. MIPS is intended to improve the quality of care while reducing costs by altering clinician payments based on clinician performance on cost and quality measures. MIPS quality measurement is increasing its focus on patient-reported outcome (PRO) measures, including for heart failure, despite limited evidence that PROs improve heart failure care. Aim 1 will be a pragmatic, single-center randomized trial evaluating whether integration of PRO assessment into the routine heart failure clinic workflow is feasible and improves health-related quality of life at one year. This patient-oriented trial will determine if the clinical impact of PRO assessment is worth the costs of data collection. Aim 2 will evaluate the association between the introduction of MIPS (in 2017) and trends in Medicare heart failure care: guideline-recommended therapy use, mortality, and costs. This study will use multiple analytic approaches and controls (VA and commercially insured heart failure patients) to develop robust estimates of these associations. This work will have a substantial impact on heart failure clinical care and patient outcomes by defining the effect of both routine PRO assessment and MIPS as a whole. It will inform the design of future clinician value-based payment models. Dr. Sandhu will use this research along with the protected time, training, and mentorship of this K23 Award to become an independent, patient-oriented health services researcher. Dr. Sandhu’s long-term research goals are to improve the quality and efficiency of heart failure patient care by evaluating the implementation of local quality improvement and national health policy. The proposed research experience and the training in clinical trials and causal inference statistics during this award is critical to achieving those goals. He will gain these skills through coursework, local research seminars, national conferences, and direct instruction from his mentorship team. His mentors are experts in implementation trials, outcomes analysis, and advanced statistical methods. They are supplemented with an exceptional advisory committee with complementary expertise in clinical trials, heart failure, and health policy. With this mentorship team and support from the Stanford Department of Medicine, Dr. Sandhu will have the tools to efficiently complete the trial in Aim 1. His rigorous training plan, the expertise of his mentors, and his experience with the data make the sophisticated policy analysis in Aim 2 feasible. Overall, the training, research, and mentorship of this award will guide Dr. Sandhu in his transition to becoming an independent, successful patient-oriented health services researcher with the skills to compete for R-level funding.