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由卫生系统提供， 研究和质量部定义为至少有一家医院和一个医师小组的组织 通过共同所有或共同管理提供全面护理。过去 十年来，卫生系统对医生实践的收购显著增加;超过一半的美国 医生现在隶属于637个卫生系统之一。研究发现，纵向一体化 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 医疗保险受益人。人们对卫生系统的扩张如何影响医疗保健知之甚少。 复杂的医疗保险患者，一个独特的人群，有很高的健康需求和频繁的互动， 医疗系统。拟议研究的长期目标是确定健康的增长是否 系统改善了对医学复杂患者的护理，以及卫生系统的战略和特点 有助于他们这样做的成功或失败。该项目的总体目标是提供保健服务， 领导者和决策者了解卫生系统是否以及如何改变服务， 医疗复杂医疗保险受益人的护理质量，重点关注获得性初级护理的患者 实践中心假设是，平均而言，卫生系统获得的做法改善了护理 对于医学上复杂的病人，但这种改善在卫生系统中各不相同。这些假设将是 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 关于医疗复杂患者的利用率、支出和质量的实践（总体和三个 （2）检查医疗支出和质量变化的卫生系统变化; 复杂的病人在后天的做法，并确定系统的特点，最能改善他们的护理; 和（3）了解医生的经验和卫生系统领导人的努力如何不同， 系统，改善医疗复杂的病人从那些没有获得的做法护理。这 该项目将使用医疗保险索赔数据和研究人员收集的定性数据。从方法上讲， 采用严格的准实验方法，包括差异中的差异分析，以及 对卫生系统领导人和执业医生进行深入的半结构化访谈。拟议研究 在申请人看来，这是创新的，因为它填补了关于健康是否、健康哪些以及健康如何的关键空白。 系统收购改善了对医学上复杂的患者的护理。它还将建立在AHRQ之前的投资基础上 开发美国卫生系统纲要，并提供一个扩大的数据库， 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， 在质量、利用率和支出成果方面进行纵向整合，并确定战略， 可以改进卫生系统的设计，创造更高价值的医疗系统。