The Effects of Bundled Payment on Acute Cardiovascular Outcomes Among Older Adults

捆绑支付对老年人急性心血管结局的影响

• 批准号: 10732365
• 负责人: Andrew M Ryan
• 金额: $ 60.75万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10732365
• 关键词: Acute; Address; Adult; Affect; American; Benchmarking; COVID-19; COVID-19 pandemic; Cardiac; Cardiac Surgery procedures; Cardiac rehabilitation; Cardiovascular Surgical Procedures; Cardiovascular system; Caring; Cessation of life; Coronary; Coronary Arteriosclerosis; Coronary Artery Bypass; Coupled; Data; Data Linkages; Econometric Models; Elderly; Exclusion; Expenditure; Frequencies; Future; Hospitals; Incentives; Inpatients; Institution; Link; Measures; Medical; Medicare; Medicare claim; Minor; Outcome; Outpatients; Patient Selection; Patient risk; Patient-Focused Outcomes; Patients; Performance; Policies; Predisposition; Price; Procedures; Public Health; Registries; Research; Risk; Role; Services; Severities; Societies; Statistical Methods; System; Testing; Thoracic Surgeon; Time; Variant; Vascularization; Voluntary Programs; acute care; bundled payment; care coordination; clinical risk; data registry; design; expectation; improved; improved outcome; innovation; mortality; novel; percutaneous coronary intervention; profiles in patients; programs

PROJECT SUMMARY Coronary artery disease causes over 360,000 annual deaths, primarily among older adults, and over $100 billion in medical expenditures. Despite improvements in outcomes, treatment remains beset by unwarranted variation in care coupled with underuse of high-value care. To address these problems, CMS has introduced several bundled payment reforms focused on cardiac procedures, including PCI and CABG. The most recent program – Bundled Payment for Care Improvement Advanced (BPCI-A) – is a voluntary program that creates incentives for hospitals to improve patient outcomes and reduce spending across a 90-day post-discharge episode. Despite the promise of bundled payment, its effects on outcomes for common cardiac procedures are not well understood. Incentives to improve care coordination and quality may encourage hospitals to reduce periprocedural complications and tightly manage post-acute care referrals. At the same time, incentives to reduce spending may encourage hospitals to avoid higher severity patients. In this context, we propose the following aims: Aim 1. Evaluate the role of hospital and patient selection related to PCI and CABG episodes in BPCI-A. We will link hospital participation in BPCI-A with Medicare data and data from the CathPCI and Society of Thoracic Surgeons Adult Cardiac Surgery registries. We will compare hospital and patient severity profiles with claims alone (the status quo in BPCI-A) and claims supplemented with registry data (the gold standard). We will then test whether hospitals with 1) lower claims-based severity compared to registry-based severity were less likely to participate in BPCI-A; and 2) patients with lower claims-based severity became less likely to be treated at participating hospitals after BPCI-A. Aim 2. Evaluate the effects of BPCI-A on periprocedural and post-discharge outcomes. Using Medicare claims and linked data from thousands of hospitals participating in the registries, we will estimate econometric models to test whether BPCI-A was associated with improvements in periprocedural complications and post-discharge outcomes. Aim 3. Evaluate how changes in BPCI-A and delivery system disruptions from COVID-19 inform the future design of bundled payment. We will exploit a change in the design of BPCI-A to examine whether including spending associated with cardiac rehabilitation in the episode led to lower cardiac rehabilitation. We will also compare hospital quality performance using claims-based and registry-based measures and test for shifts in patient severity profiles for patients receiving inpatient and outpatient PCI. Finally, we will examine the accuracy of target prices before and after COVID-19. This proposal is significant because it will be the first to understand the effects of BPCI-A on selection and outcomes for cardiac procedures using high quality registry data. The proposal is innovative in its use of novel data linkages and statistical methods to understand the impact of this critical policy question affecting millions of older adults with coronary artery disease.

项目摘要 冠状动脉疾病每年导致超过360，000人死亡，主要是老年人， 亿美元的医疗支出。尽管结果有所改善，但治疗仍然受到无根据的 护理的差异加上高价值护理的利用不足。为了解决这些问题，CMS引入了 几项捆绑式支付改革的重点是心脏手术，包括PCI和CABG。最近的 Bundled Payment for Care Improvement Advanced（BPCI-A）是一项自愿计划， 鼓励医院改善患者治疗效果并减少出院后90天内的支出 插曲。尽管承诺捆绑支付，但其对常见心脏手术结果的影响 没有很好地理解。改善护理协调和质量的激励措施可能会鼓励医院减少 围手术期并发症和严格管理急性期后护理转诊。与此同时， 减少开支可能会鼓励医院避免更严重的病人。在这方面，我们建议 目标：目标1。评价与PCI和CABG事件相关的医院和患者选择在 BPCI-A。我们将把医院参与BPCI-A与医疗保险数据和CathPCI的数据联系起来， 胸外科医师学会成人心脏手术登记中心。我们将比较医院和病人的严重程度 仅含索赔的概况（BPCI-A中的现状）和补充有登记数据的索赔（黄金 标准）。然后，我们将测试1）与基于注册的相比，基于索赔的严重程度较低的医院 严重程度较低的患者不太可能参加BPCI-A; 2）基于索赔的严重程度较低的患者变得更少 在BPCI-A之后可能在参与医院接受治疗。目标2.评估BPCI-A对以下方面的影响 围手术期和出院后结局。使用医疗保险索赔和来自数千个 参与登记研究的医院，我们将估计计量经济学模型，以检验BPCI-A是否 与围手术期并发症和出院后结局的改善相关。目标3.评价 BPCI-A的变化和COVID-19导致的交付系统中断如何为未来的捆绑式 支付我们将利用BPCI-A设计中的变化来检查是否包括相关支出 心脏康复的发作导致较低的心脏康复。我们还将比较医院 使用基于索赔和基于注册的措施和患者严重程度变化测试的质量性能 接受住院和门诊PCI的患者的概况。最后，我们将检查目标的准确性 COVID-19前后的价格。这一建议意义重大，因为它将是第一个了解 使用高质量登记数据，研究BPCI-A对心脏手术选择和结局的影响。的 该提案在使用新的数据联系和统计方法来了解这一影响方面具有创新性。 关键的政策问题，影响数百万老年人与冠状动脉疾病。