Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria

飓风玛丽亚后波多黎各医生组织的初级保健转型

• 批准号: 10584572
• 负责人: Justin W. Timbie
• 金额: $ 72.71万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584572
• 关键词: Address; Advisory Committees; Alternative Health; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Area; Caregivers; Caring; Cessation of life; Clinic; Collaborations; Complex; Contracts; Data; Disasters; Economics; Elderly; Eligibility Determination; Enrollment; Federal Government; Federally Qualified Health Center; Fee-for-Service Plans; Financial Support; Funding; Future; Geography; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hispanic Americans; Hospitals; Hurricane; Incentives; Infrastructure; Interview; Investments; Long-Term Care; Long-Term Effects; Low income; Managed Care; Measures; Medicaid; Medical; Medicare; Methods; Modeling; Organizational Models; Outcome; Performance; Physicians; Policy Maker; Primary Care; Primary Care Physician; Protocols documentation; Provider; Puerto Rico; Quality of Care; Recording of previous events; Recovery; Research; Research Personnel; Resource-limited setting; Services; Shapes; Surgeon; System; United States Agency for Healthcare Research and Quality; Universities; Water; beneficiary; care coordination; care delivery; college; design; dual eligible; experience; falls; food shortage; health care delivery; health care service; health care service organization; health disparity; health disparity populations; health plan; implementation barriers; improved; informal caregiver; interest; medical specialties; migration; older patient; patient advocacy group; payment; recruit; telehealth; trend

Project Summary/Abstract In September 2017, Hurricane Maria brought unprecedented devastation to Puerto Rico. The Hurricane’s impact was disproportionately borne by elderly patients and residents of remote areas of Puerto Rico who were vulnerable to disruptions in health care services. Providers and policymakers are currently seeking to make major investments in Puerto Rico’s primary care delivery system that were outlined in Puerto Rico’s recovery plan. However, the ability of Puerto Rico’s physician organizations (POs) to undertake large-scale primary care transformation remains unclear. In particular, POs might differ widely in both their existing primary care infrastructure as well as the level of technical or financial support they typically receive to implement new infrastructure from the health systems or independent physicians associations with which they are affiliated, from the Medicare Advantage plans and Medicaid managed care organizations with which they contract, or from the federal government. The proposed study, which builds on an existing collaboration between RAND and the University of Puerto Rico, will examine four models of physician organization in Puerto Rico: federally qualified health centers, small independent medical groups, large independent medical groups, and vertically- integrated medical groups. We will use Medicare fee-for-service claims and Medicare Advantage encounter data to assess trends in the physician workforce providing care through these four delivery models, the Medicare beneficiaries who receive care through each model, and changes in both trends following Hurricane Maria. We will then assess changes in access, quality of care, and care coordination before and after Hurricane Maria to measure differences in performance across PO models and to identify high-performing POs and low-performing POs in each model. We will conduct interviews with leaders of 32 of the highest-performing POs and lowest-performing POs in each model to identify the advanced primary care infrastructure they have sought to implement as well as implementation barriers. Finally, we will interview Medicare beneficiaries living with Alzheimer’s disease (or Alzheimer’s disease related dementias) and their caregivers to better understand their unmet care needs and how these needs differ across the four PO models. The research will be guided and supported by an Advisory Committee comprising representatives of two local provider associations and two local patient advocacy groups that represent older adults and people living with Alzheimer’s disease and Alzheimer’s disease related dementias. The study will help to identify specific models of physician organization that are associated with higher performance that could help guide Puerto Rico’s Hurricane Maria recovery effort. Our findings could also help stakeholders prioritize the expansion of specific services that could most directly improve the lives of patients with Alzheimer’s disease or Alzheimer’s disease related dementias and their caregivers and identify the types of POs that might need greater support to address current gaps.

项目总结/摘要 2017年9月，飓风玛丽亚给波多黎各带来了前所未有的破坏。飓风的 老年病人和波多黎各偏远地区的居民承受了不成比例的影响， 容易受到医疗服务中断的影响。供应商和政策制定者目前正在寻求使 在波多黎各的复苏中概述的对波多黎各初级保健提供系统的重大投资 计划然而，波多黎各的医生组织开展大规模初级保健的能力 转型仍不明朗。特别是，PO在其现有的初级保健和 基础设施以及他们通常获得的技术或财政支持水平，以实施新的 卫生系统或其所属的独立医生协会的基础设施， 与他们签订合同的Medicare Advantage计划和Medicaid管理式医疗机构，或 来自联邦政府拟议中的研究建立在兰德公司与 和波多黎各大学，将研究四种模式的医生组织在波多黎各：联邦 合格的健康中心，小型独立医疗集团，大型独立医疗集团，以及纵向- 综合医疗集团。我们将使用Medicare按服务收费索赔和Medicare Advantage遭遇 数据，以评估通过这四种交付模式提供护理的医生队伍的趋势， 通过每种模式接受护理的医疗保险受益人，以及飓风后两种趋势的变化 玛利亚然后，我们将评估治疗前后在获得、护理质量和护理协调方面的变化 Hurricane Maria用于衡量PO模型之间的性能差异，并识别高性能PO 和低性能的PO。我们将采访32位表现最好的领导人， 每个模型中的PO和表现最差的PO，以确定其拥有的高级初级保健基础设施 以及执行障碍。最后，我们将采访生活在 阿尔茨海默病（或阿尔茨海默病相关痴呆）及其护理人员，以更好地了解 他们未得到满足的护理需求以及这些需求在四种PO模式中的差异。该研究将指导 并由一个由两个当地供应商协会代表组成的咨询委员会提供支持， 两个代表老年人和阿尔茨海默病患者的当地患者倡导团体， 阿尔茨海默病相关痴呆症。这项研究将有助于确定医生组织的具体模式 与更高的性能相关，可以帮助指导波多黎各的飓风玛丽亚恢复 努力我们的研究结果还可以帮助利益相关者优先考虑扩展特定服务， 直接改善阿尔茨海默病或阿尔茨海默病相关痴呆患者的生活， 他们的照顾者，并确定可能需要更多支持以解决当前差距的参与组织类型。