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Impact of Medicaid ACO funding for health-related social needs on dietary quality and health

医疗补助 ACO 资助与健康相关的社会需求对饮食质量和健康的影响

基本信息

批准号：
10249260
负责人：
Anne N Thorndike
金额：
$ 64.92万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-17 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10249260
关键词：
Acute Address Adoption Adult Affect Anxiety Behavioral Blood Pressure Body mass index Cardiometabolic Disease Cardiovascular Diseases Caring Chronic Disease Communities Contracts Data Diabetes Mellitus Diet Dietary Assessment Dietary intake Effectiveness Electronic Health Record Emergency department visit Enrollment Financial Hardship Food Funding Future Glycosylated hemoglobin A Goals Government Health Health system Healthcare Hospitalization Hour Housing Impairment Incentives Insurance Coverage Knowledge Lead Lipids Massachusetts Measures Medicaid Medical Mental Depression Morbidity - disease rate Natural experiment Neighborhood Health Center Nutritional Obesity Outcome Participant Pathway interactions Patients Policies Practical, Robust Implementation and Sustainability Model Program Effectiveness Provider Psychological Stress Qualitative Methods Reach, Effectiveness, Adoption, Implementation, and Maintenance Reporting Research Research Personnel Resources Risk S-nitro-N-acetylpenicillamine Self Management Services Social Work Socioeconomic Status Stress Surveys System Time Work cancer health disparity cardiometabolism care delivery dietary effectiveness evaluation experimental study flexibility food environment food insecurity health care service organization health care service utilization health organization housing instability implementation determinants implementation outcomes improved income disparities insight mortality novel patient oriented patient screening payment perceived stress primary outcome programs screening service organization service programs social social determinants social health determinants social organization

项目摘要

Despite major advances in therapies, disparities in cancer and cardiometabolic outcomes continue to widen due to differences in socioeconomic status. Food and housing insecurity are social determinants of health that are associated with morbidity from obesity, diabetes, cardiovascular disease, and psychological stress, and food insecurity contributes to income disparities in cancer mortality. Although the associations between social needs and health are well-defined, there is a research gap as to whether policies or programs to address food and housing insecurity, particularly through health systems, improve diet, obesity, health, and healthcare utilization. Some states are experimenting with Accountable Care Organizations (ACOs) in their Medicaid programs with the goal of incentivizing providers and organizations to deliver higher value care, and some ACOs are starting to address social needs. In January 2020, the state of Massachusetts will, for the first time, provide funding directly to Medicaid ACOs to address food and housing needs through the Delivery System Reform Incentive Payment Flexible Services program. Implementation of this program is a natural experiment that could provide important knowledge about the impact of state-level funding for food and housing needs on diet and health outcomes. The main objectives of this study are to evaluate how the Flexible Services program affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and to assess program implementation. The project will take place at five community health centers (CHCs) affiliated with Partners HealthCare, a large health care organization that has contracted with the state as a Medicaid ACO. The project is time-sensitive because the pre-program implementation assessment of diet, stress, food/housing insecurity, and access to resources must be completed before program implementation in 2020. A total of 800 Medicaid ACO patients (Med-ACO) and 200 non-Medicaid CHC patients with food/housing insecurity (Control) will be enrolled and followed for 4 years. Survey, 24-hour dietary recall (ASA24), electronic health record (EHR), and claims data will be collected. Primary outcomes will be change in dietary quality, stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health care utilization (emergency department visits; hospitalizations) (Aim 2) comparing: a) Med-ACO participants who screen positive for food/housing insecurity pre-implementation vs. Control, and b) Med-ACO participants who screen positive for food/housing and receive Flexible Services (exposed) vs. Med-ACO participants who screen positive but do not receive Flexible Services (not exposed). Aim 3 will assess implementation factors that influence the effectiveness of the program, guided by the RE-AIM/PRISM framework. Results will inform policymakers and researchers about the effectiveness of a novel state-level program for delivering food and housing resources through Medicaid ACOs and will help refine ongoing and future state and community programs that will reduce income disparities in cancer and cardiometabolic disease.

尽管在治疗方面取得了重大进展，但癌症和心脏代谢结果的差异继续扩大