Health care hotspotting: inside the Camden Coalition's superutilizer program
医疗保健热点:卡姆登联盟超级利用者计划内部
基本信息
- 批准号:10688328
- 负责人:
- 金额:$ 59.78万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2015
- 资助国家:美国
- 起止时间:2015-09-15 至 2024-08-31
- 项目状态:已结题
- 来源:
- 关键词:AddressAdmission activityAgeAmbulatory CareAppointmentAttentionAutopsyBudgetsCaringCategoriesChronicCitiesComplexConsensusDataDrug PrescriptionsDurable Medical EquipmentElderlyElementsEnrollmentEvaluationFailureFederal GovernmentFundingFutureGoalsGovernmentHealthHealth Care CoalitionsHealth Care CostsHealth PersonnelHealth behaviorHealthcareHealthcare SystemsHome visitationHospitalizationHospitalsIndividualIntensive CareInterventionInterviewJournalsLearningLightMeasuresMedicaidMedicalMedicareMedicineModelingNew EnglandObservational StudyOutcomeOutpatientsPatient-Focused OutcomesPatientsPersonal SatisfactionPersonsPopulationPrimary Health CareProtocols documentationProxyPublishingQuality of CareRandomizedRandomized Controlled TrialsRecordsResearchResearch PersonnelSeminalServicesSpecialistSystemTheory of ChangeTimeUnited StatesWorkbaby boomercare coordinationcare deliverycare fragmentationcostfollow-uphealth care qualityhealth care service utilizationhospital readmissionhospital utilizationimplementation barriersimprovedinnovationinterestmedication compliancepatient home carepressurepreventprimary outcomeprogramsprospectiverandomized controlled designreadmission ratessecondary outcomesocialstudy populationtheorieswasting
项目摘要
ABSTRACT
This project extends the analysis of a randomized controlled trial of the Camden Coalition of Healthcare
Providers’ complex care management program, an intervention that aims to reduce spending and improve
healthcare quality and health outcomes by targeting “superutilizers” of the healthcare system. The program
focuses on patients with chronic conditions, complex needs, and frequent hospitalizations, working with them
after discharge to prevent future admissions. The program is motivated by the fact that healthcare costs (which
account for almost 18 percent of GDP in the US) are heavily concentrated. It targets a group that accounts for
less than two percent of the Camden population but more than a quarter of total spending at Camden
hospitals.
Our previous randomized controlled trial found that the care coordination program failed to reduce hospital
readmissions, but it could not explain why. This follow-up research will address this unanswered question by
investigating new outcomes that distinguish between two very different explanations with very different
implications: a failure of trial fidelity to the program or of the underlying theory behind the program. Was
postdischarge care coordination (such as getting patients to primary care appointments in a timely manner) not
achieved or was it insufficient to prevent readmissions? This work is a rare opportunity to conduct a
postmortem on a critically important but limited RCT and chart a path forward for improving care for medically
and socially complex patients.
We leverage rich Medicaid data to investigate these alternative explanations for the lack of program impact on
hospital readmissions, expanding the scope of inquiry beyond hospital utilization to shed light on the program’s
impact on other important healthcare utilization and health behaviors, which are key elements of the program’s
theory of change. The specific aims are motivated by a need to better understand the null findings on hospital
readmissions, inform the current debate over their interpretation, and investigate potential impacts of the
intervention outside of the hospital setting. We will use the randomized controlled design to investigate the
impact of the Camden program on (1) Quantity of outpatient care, including primary care, specialist care,
prescription drugs, home care, and durable medical equipment; (2) Quality of outpatient care, as proxied by
measures of care fragmentation and whether care was received in a timely manner after discharge; and (3)
Patient health behaviors, including medication adherence and the stability of enrollment in Medicaid. We will
also conduct interviews with program staff to understand implementation challenges, contextualize findings,
and generate new hypotheses.
摘要
该项目扩展了对卡姆登医疗保健联盟的随机对照试验的分析
提供者的复杂护理管理计划,旨在减少支出和改善
通过瞄准医疗系统的“超级利用者”,提高医疗质量和健康结果。该计划
重点关注慢性病、复杂需求和频繁住院的患者,与他们合作
在出院后,以防止未来的入院。该计划的动机是医疗费用(其中
占美国GDP的近18%)高度集中。它的目标群体是占
不到卡姆登人口的2%,但超过卡姆登总支出的四分之一
医院。
我们之前的随机对照试验发现,护理协调计划未能减少医院
重新入院,但无法解释原因。这项后续研究将通过以下方式解决这一悬而未决的问题
研究区分两种截然不同的解释的新结果
暗示:试验对计划或计划背后的基本理论的忠诚度的失败。曾经是
出院后护理协调(如及时让病人到初级保健预约)不
是否已达到或不足以阻止重新接纳?这项工作是一次难得的机会
对一项极其重要但有限的RCT进行尸检,并为改善医疗保健制定前进道路
以及社交复杂的病人。
我们利用丰富的医疗补助数据来调查这些对计划缺乏影响的替代解释
再次住院,将调查范围扩大到医院利用之外,以阐明该计划的
对其他重要的医疗保健利用和健康行为的影响,这些都是该计划的关键要素
变化论。具体目标的动机是需要更好地理解关于医院的无效发现
重新接纳,告知目前关于他们的解释的辩论,并调查
医院环境外的干预。我们将使用随机对照设计来研究
卡姆登计划对(1)门诊护理数量的影响,包括初级保健、专科护理、
处方药、家庭护理和耐用的医疗设备;(2)门诊护理的质量,由
护理分散的措施,以及出院后是否及时得到护理;和(3)
患者的健康行为,包括服药依从性和参加医疗补助的稳定性。我们会
还与计划人员进行面谈,以了解实施挑战,将结果与背景相结合,
并产生新的假设。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Amy N. Finkelstein其他文献
Financial Incentives to Facilities and Clinicians Treating Patients With End-stage Kidney Disease and Use of Home Dialysis
对治疗终末期肾病患者和使用家庭透析的设施和临床医生的经济激励
- DOI:
- 发表时间:
2022 - 期刊:
- 影响因子:0
- 作者:
Yunan Ji;L. Einav;Neale Mahoney;Amy N. Finkelstein - 通讯作者:
Amy N. Finkelstein
Pricing Efficiently in Designed Markets: The Case of Ride-Sharing∗
设计市场中的有效定价:乘车共享案例*
- DOI:
- 发表时间:
2019 - 期刊:
- 影响因子:0
- 作者:
Jonathan V. Hall;J. Horton;Nyu Stern;Daniel T. Knoepfle;Peter Cohen;Keith Chen;J. Chevalier;Will Dobbie;Arindrajit Dubé;M. Duggan;Amy N. Finkelstein;H. Farber;Andrey Fradkin - 通讯作者:
Andrey Fradkin
Producing Health: Measuring Value Added of Nursing Homes
创造健康:衡量疗养院的附加值
- DOI:
- 发表时间:
2022 - 期刊:
- 影响因子:0
- 作者:
L. Einav;Amy N. Finkelstein;Neale Mahoney - 通讯作者:
Neale Mahoney
Moral Hazard in Health Insurance: How Important is Forward Looking Behavior?
健康保险中的道德风险:前瞻性行为有多重要?
- DOI:
- 发表时间:
2012 - 期刊:
- 影响因子:0
- 作者:
Aviva Aron;L. Einav;Amy N. Finkelstein;M. Cullen - 通讯作者:
M. Cullen
What Premium Support Options Did CBO Analyze ? 1 How Would the Premium Support Options Affect Federal Spending ? 2 How Would the Premium Support Options Affect Beneficiaries ’ Premiums ?
CBO 分析了哪些保费支持选项? 1 保费支持选项将如何影响联邦支出? 2 保费支持选项将如何影响受益人的保费?
- DOI:
- 发表时间:
2013 - 期刊:
- 影响因子:0
- 作者:
L. Einav;Amy N. Finkelstein;Pietro Tebaldi - 通讯作者:
Pietro Tebaldi
Amy N. Finkelstein的其他文献
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{{ truncateString('Amy N. Finkelstein', 18)}}的其他基金
MIT Roybal Center for Translational Research to Improve Healthcare for the Aging
麻省理工学院皇家转化研究中心改善老龄化医疗保健
- 批准号:
10212215 - 财政年份:2020
- 资助金额:
$ 59.78万 - 项目类别:
MIT Roybal Center for Translational Research to Improve Healthcare for the Aging
麻省理工学院皇家转化研究中心改善老龄化医疗保健
- 批准号:
10462486 - 财政年份:2020
- 资助金额:
$ 59.78万 - 项目类别:
MIT Roybal Center for Translational Research to Improve Healthcare for the Aging
麻省理工学院皇家转化研究中心改善老龄化医疗保健
- 批准号:
10678952 - 财政年份:2020
- 资助金额:
$ 59.78万 - 项目类别:
MIT Roybal Center for Translational Research to Improve Healthcare for the Aging
麻省理工学院皇家转化研究中心改善老龄化医疗保健
- 批准号:
10347797 - 财政年份:2020
- 资助金额:
$ 59.78万 - 项目类别:
MIT Roybal Center for Translational Research to Improve Healthcare for the Aging
麻省理工学院皇家转化研究中心改善老龄化医疗保健
- 批准号:
10281469 - 财政年份:2020
- 资助金额:
$ 59.78万 - 项目类别: