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.

项目摘要 美国的医疗保健越来越多地在卫生系统中进行 - 医疗机构 研究和质量已定义为至少一家医院和一个物理组织的组织 提供通过共同所有权或联合管理运营的综合护理。在过去 十年来，卫生系统对身体实践的获取显着增加。美国一半以上 医师现在有资格获得637个卫生系统之一。先前的研究发现垂直整合 可能导致更高的商业保健价格，但对质量，支出和利用有不确定的影响 用于医疗保险受益人。关于卫生系统的扩展如何影响医学的护理知之甚少 复杂的Medicare患者，一个独特的人群，具有很高的健康需求，并且经常与 医疗系统。拟议研究的长期目标是确定健康的增长是否 系统改善医疗复杂患者的护理以及哪些卫生系统策略和特征 为他们的成功或失败做出贡献。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交付以及 医学复杂的医疗保险受益人的护理质量，重点是获得的初级保健患者 实践。核心假设是，平均而言，卫生系统的实践获取可以改善护理 对于医疗复杂的患者，但这种改善在卫生系统上有所不同。这些假设将是 通过追求三个具体目标测试：（1）确定卫生系统获得初级保健的影响 医学复杂患者的利用，支出和质量的实践（总体而言，三个 亚群）； （2）卫生系统在医学上进行的支出和质量变化的检查变化 在获得的实践中，复杂的患者，并确定最能改善其护理的系统的特征； （3）了解医生的经历以及卫生系统领导人的努力如何不同 从没有的方法中改善对医学复杂患者的护理的系统。这 项目将使用研究人员收集的Medicare索赔数据和定性数据。从方法上讲，它将 采用严格的准实验方法，包括差异分析的差异，以及 深度，半结构化访谈与卫生系统领导者和实践医生。拟议的研究 在申请人的意见中，具有创新性，因为它填补了关于哪种，哪个以及如何健康的关键差距 系统采集改善了医学复杂患者的护理。它也将基于AHRQ先前的投资 在开发美国卫生系统的汇编时，并将扩展的数据库公开可用 其他研究人员要使用。该项目很重要，因为它将提供有关影响的严格证据 跨各种质量，利用和支出成果的垂直整合，并将确定策略 可以改善卫生系统的设计以创建更高的价值医疗系统。