Health Systems and High-Need Populations: The Effect of Vertical Integration on Utilization, Spending, and Quality for Medically ComplexPatients

卫生系统和高需求人群：垂直整合对医疗复杂患者的利用、支出和质量的影响

• 批准号: 10660622
• 负责人: Amelia Bond
• 金额: $ 39.95万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10660622
• 关键词: Health; Systems; Need; Populations; Effect

PROJECT SUMMARY Medical care in the United States is increasingly delivered in health systems—which the Agency for Healthcare Research and Quality has defined as organizations with at least one hospital and one physician group providing comprehensive care that operate through common ownership or joint management. In the past decade, health system acquisition of physician practices has increased markedly; more than half of U.S. physicians are now affiliated with one of 637 health systems. Prior research has found that vertical integration can lead to higher commercial health care prices, but has uncertain effects on quality, spending, and utilization for Medicare beneficiaries. Little is known about how health system expansion influences care for medically complex Medicare patients, a distinct population that has high health needs and frequent interactions with the medical system. The long-term goal of the proposed research is to determine whether the growth of health systems improves care for medically complex patients and what health system strategies and characteristics contribute to their success or failure in doing so. The overall objective of this project is to provide health care leaders and policymakers with an understanding of whether and how health systems change the delivery and quality of care for medically complex Medicare beneficiaries, with a focus on patients in acquired primary care practices. The central hypotheses are that, on average, health system acquisition of practices improves care for medically complex patients, but that improvement varies across health systems. These hypotheses will be tested by pursuing three specific aims: (1) determine the impact of health system acquisition of primary care practices on utilization, spending, and quality for medically complex patients (overall and for three subpopulations); (2) examine variation by health system in spending and quality changes for medically complex patients at acquired practices, and identify characteristics of systems that most improve their care; and (3) understand how the experiences of physicians and the efforts of health system leaders differ at systems that improve care for medically complex patients at acquired practices from those that do not. This project will use Medicare claims data and qualitative data collected by the researchers. Methodologically, it will employ rigorous quasi-experimental approaches including difference-in-differences analyses, as well as in- depth, semi-structured interviews with health system leaders and practicing physicians. The proposed research is innovative, in the applicants' opinion, because it fills critical gaps about whether, which, and how health system acquisitions improve care for medically complex patients. It will also build on AHRQ's prior investment in developing a Compendium of U.S. Health Systems, and make an expanded database publicly available for other researchers to use. The project is significant because it will provide rigorous evidence on the impact of vertical integration across a range of quality, utilization, and spending outcomes and will identify strategies that may improve the design of health systems to create a higher value medical system.

项目概要 美国的医疗保健越来越多地由卫生系统提供——卫生保健机构 研究和质量被定义为至少拥有一家医院和一个医生小组的组织 通过共同所有权或共同管理提供全面的护理。在过去 十年来，卫生系统对医生执业的获取显着增加；超过一半的美国 医生现在隶属于 637 个卫生系统之一。先前的研究发现，垂直整合 可能导致商业医疗保健价格上涨，但对质量、支出和利用率产生不确定的影响 对于医疗保险受益人。人们对卫生系统扩张如何影响医疗保健知之甚少 复杂的医疗保险患者是一个具有高健康需求并与医疗机构频繁互动的独特人群 医疗系统。拟议研究的长期目标是确定健康的增长是否 系统改善了对病情复杂的患者的护理以及卫生系统的策略和特点 影响他们这样做的成功或失败。该项目的总体目标是提供医疗保健 领导者和政策制定者了解卫生系统是否以及如何改变提供和服务 医疗复杂的医疗保险受益人的护理质量，重点关注获得初级护理的患者 做法。中心假设是，平均而言，卫生系统获得实践可以改善护理 对于病情复杂的患者来说，但这种改善因卫生系统而异。这些假设将 通过追求三个具体目标进行测试：(1) 确定卫生系统获得初级保健的影响 医疗复杂患者的利用、支出和质量实践（总体和三 亚群）； (2) 检查卫生系统在医疗支出和质量变化方面的变化 在获得的实践中复杂的患者，并确定最能改善他们护理的系统的特征； (3) 了解医生的经验和卫生系统领导者的努力有何不同 系统可以从那些不具备医疗复杂性的患者那里获得实践，从而改善对医疗复杂患者的护理。这 项目将使用研究人员收集的医疗保险索赔数据和定性数据。从方法论上讲，它将 采用严格的准实验方法，包括双重差异分析以及in- 对卫生系统领导者和执业医师进行深度、半结构化访谈。拟议的研究 申请人认为，这是创新性的，因为它填补了关于是否、哪些以及如何健康的关键空白。 系统采购改善了对病情复杂的患者的护理。它还将建立在 AHRQ 先前投资的基础上 开发美国卫生系统纲要，并公开扩展数据库 其他研究人员使用。该项目意义重大，因为它将提供严格的证据来证明 跨一系列质量、利用率和支出结果的垂直整合，并将确定战略 可以改进卫生系统的设计，创造更高价值的医疗系统。