New York State Health Home Impact on HIV Treatment Cascade

纽约州健康之家对艾滋病毒治疗级联的影响

• 批准号: 8771003
• 负责人: JON MORGENSTERN
• 金额: $ 67.16万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8771003
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anti-Retroviral Agents; Behavioral; Bipolar Disorder; Caring; Case Manager; Characteristics; Chronic Disease; Client; Clinical; Continuity of Patient Care; Contracts; Country; Data; Data Set; Drug Metabolic Detoxication; Effectiveness; Enrollment; Glycosylated hemoglobin A; HIV; HIV Seropositivity; Health; Health Care Costs; Health Care Reform; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; High Prevalence; Home environment; Homeless persons; Homelessness; Housing; Human immunodeficiency virus test; Indigent; Individual; Infection; Inpatients; Intervention Studies; Knowledge; Life; Low income; Measures; Medicaid; Medical; Mental Health; Mental disorders; Methods; Metric; Mood stabilizers; Nature; New York; Outcome; Paint; Participant; Patients; Persons; Policies; Population; Provider; Public Health; Public Sector; Qualitative Research; Quality of Care; Quality of life; Regimen; Reporting; Research; Research Methodology; Risk; Series; Services; Social Work; Substance Use Disorder; System; Technology; Testing; Time; United States; Viral; Viral Load result; antiretroviral therapy; behavioral health; care systems; compliance behavior; cost; diabetic; evidence base; housing instability; improved; longitudinal design; medication compliance; novel strategies; programs; public health relevance; social; stem; supported housing; surveillance data; transmission process

DESCRIPTION (provided by applicant): In order to slow the spread of HIV and improve health outcomes for persons living with HIV/AIDS (PLWHA), the Affordable Care Act greatly expands access to health care for low-income PLWHA. Further, the Office of National AIDS Policy has created a strategy to improve the current system of care by closing gaps in the HIV care continuum. The HIV care continuum outlines a series of steps in addressing infection: a) HIV testing, b) engagement in HIV care, c) participation in antiretroviral therapy (ART), and d) the ultimate target-viral suppression. Surveillance data paint a dismal picture of the continuum of care in the United States, with less than 25% of PLWHA having undetectable viral load. Given the fragmented, crisis-driven nature of the current health care system, individuals who are homeless or unstably housed may continue to receive low quality care or no care at all. The high prevalence of substance use disorders, mental illness, and other chronic illnesses among unstably housed, HIV-positive individuals increases the difficulty in engaging this group in care. The Affordable Care Act includes a number of important healthcare system restructuring provisions for chronic illness management, among which are Health Homes (HH) for Medicaid recipients. New York (NY) Department of Health (DOH) has created one of the country's earliest and most ambitious implementations of HHs. NY HH's are newly formed integrated healthcare networks of medical and behavioral health providers that contract to provide integrated care through shared care managers and common technology platforms. Additionally, NY DOH has a pilot program to provide 544 units of supportive housing (SH) for homeless PLWHA enrolled in HHs. This study will test 1) whether SH combined with HHs improves quality of care for 544 homeless PLWHA HH enrollees and 2) whether New York HH improve quality of care and costs to 8,250 Medicaid homeless PLWHA enrolled in HHs. The primary aims will be addressed in two ways. First, we will compare HIV continuum and other quality metrics and Medicaid costs between homeless PLWHA in SH and those who did not receive supportive housing using nonparametric difference-in-difference methods. Second, we will implement a longitudinal design using administrative data from 2009 through 2016 to examine changes in quality of care and Medicaid costs for homeless PLWHA in Medicaid. The project comes from an academic- public sector partnership to address high priority questions of healthcare system redesign. Data will come from surveillance data on all HIV lab tests conducted in NY, Medicaid encounters/claims, and from HHs reporting on client functioning and care manager contacts. These data will be merged to create DE identified analytical datasets by DOH. Additional qualitative research methods will be employed to elucidate the HH factors associated with outcomes. If aims are achieved, the study is likely to have a major impact on improving knowledge about evidence-based approaches to address homeless PLWHA. In addition, because the study intervention is part of ACA, the policy impact of the study findings on national healthcare may be substantial.

描述（由申请人提供）：为了减缓艾滋病毒的传播并改善艾滋病毒/艾滋病感染者（PLWHA）的健康状况，《负担得起的医疗法案》大大扩大了低收入的PLWHA获得医疗保健的机会。此外，国家艾滋病政策办公室制定了一项战略，通过缩小艾滋病毒护理连续体中的差距来改善目前的护理系统。艾滋病毒护理连续体概述了处理感染的一系列步骤：a)艾滋病毒检测，b)参与艾滋病毒护理，c)参与抗逆转录病毒治疗，d)最终目标-病毒抑制。在美国，监测数据描绘了一幅令人沮丧的连续治疗图景，不到25%的艾滋病感染者病毒载量无法检测到。鉴于当前卫生保健系统支离破碎、危机驱动的性质，无家可归或居住不稳定的个人可能继续得到低质量的护理，甚至根本得不到护理。在住房不稳定的艾滋病毒阳性个体中，物质使用障碍、精神疾病和其他慢性疾病的高流行率增加了让这一群体接受护理的难度。《平价医疗法案》包括一些重要的医疗保健系统重组规定，用于慢性病管理，其中包括医疗补助接受者的健康之家（HH）。纽约（NY）卫生部（DOH）创建了全国最早和最雄心勃勃的卫生保健实施之一。纽约HH是新成立的综合医疗保健网络，由医疗和行为健康提供者组成，通过共享护理管理器和通用技术平台提供综合护理。此外，纽约卫生部有一个试点方案，为在卫生保健中心登记的无家可归的艾滋病感染者提供544套支持性住房。本研究将测试1)SH联合HHs是否改善了544名无家可归的PLWHA HH入组者的护理质量；2)纽约HH是否改善了8250名在HHs入组的医疗补助无家可归的PLWHA患者的护理质量和成本。主要目标将通过两种方式实现。首先，我们将使用非参数差中差法比较居住在贫民窟的无家可归的艾滋病感染者和没有获得支持性住房的感染者之间的艾滋病连续体和其他质量指标以及医疗补助成本。其次，我们将使用2009年至2016年的行政数据实施纵向设计，以检查医疗补助计划中无家可归的艾滋病感染者的护理质量和医疗补助费用的变化。该项目来自学术-公共部门的合作伙伴关系，以解决医疗保健系统重新设计的高优先级问题。数据将来自纽约进行的所有艾滋病毒实验室检测的监测数据，医疗补助遭遇/索赔，以及卫生保健部门关于客户功能和护理经理联系的报告。这些数据将由DOH合并创建DE识别的分析数据集。额外的定性研究方法将用于阐明与结果相关的HH因素。如果目标得以实现，该研究可能会对提高对以证据为基础的方法解决无家可归的艾滋病感染者问题的认识产生重大影响。此外，由于研究干预是ACA的一部分，研究结果对国家医疗保健的政策影响可能是实质性的。