Impacts of payment models on the organization of hospital care and outcomes for persons with mental illness

 描述（由申请人提供）：这项观察性研究通过比较马里兰州（实施了支付改革）与宾夕法尼亚州（未实施）的趋势，检查了全州医院支付改革对慢性精神疾病患者医院护理的影响。2014年，马里兰州从按服务收费的医院支付系统过渡到以人口为基础的支付系统，其特点是前瞻性分配全球预算和绩效激励。医院筹资方面的这一变化预计将导致对慢性病患者的医院护理进行重组。特别是对于精神病患者，预计这将使他们的精神健康和一般医疗保健更好地结合起来，增加住院后的门诊随访，并减少再次入院。然而，在较长的一段时间内，逆向选择产生的激励可能会导致一些医院减少他们提供的精神卫生服务和精神卫生人员的数量。该研究的具体目的是检查马里兰州的支付改革如何影响：1）住院后门诊随访、过渡性护理管理和/或护理整合服务的接收; 2）住院患者再入院; 3）和总住院费用;和4）采用定性方法探讨医院临床领导对马里兰州医院支付改革如何影响护理整合和获得需要门诊医疗对于目标1-3，使用回归分析分析2012年至2017年期间在马里兰州或宾夕法尼亚州因精神疾病或一般医疗护理条件住院的精神疾病成人（18岁以上）的护理结局过程。对于目标4，我们正在完成对医院临床项目主任的定性访谈。这项研究是及时和重要的，因为它将提供一些基于人口的医院系统融资的影响的第一个估计与严格的预算控制对护理协调和整合的个人与复杂的心理健康状况。这项拟议中的研究既及时又具有创新性，因为其结果将为政策制定者评估类似改革可能如何影响慢性精神疾病患者的医院护理质量和价值提供信息 以及一个或多个共同发生的慢性医学问题。

 DESCRIPTION (provided by applicant): This observational study examines the impacts of a statewide hospital payment reform on the hospital care of persons with chronic mental illness by comparing trends in Maryland, which implemented the payment reform, to trends in Pennsylvania, which did not. In 2014, Maryland transitioned from a fee-for-service hospital payment system to a population-based payment system characterized by prospectively assigned global budgets and performance incentives. This change in hospital financing is expected to result in re-organization of hospital care for persons with chronic conditions. For persons with mental illnesses, in particular, it is expected to result in greater integration of thir mental health and general medical care, increased outpatient follow-up following an inpatient stay, and reduced hospital readmissions. However, over a longer time period, incentives created by adverse selection may lead some hospitals to reduce the array of mental health services they offer and their mental health staffing levels. The study's specific aims are to examine how Maryland's payment reform affected: 1) receipt of outpatient follow-up, transitional care management, and/or care integration services after an inpatient stay; 2) inpatient readmission; and 3) and total hospital spending; and 4) to use qualitative methods to explore hospital clinical leaders' perceptions of how Maryland's hospital payment reform affected care integration and access to needed outpatient health care. For Aims 1-3, regression analysis is being used to analyze process of care outcomes for adults (ages 18+) with mental illness who were hospitalized in calendar years 2012 to 2017 in Maryland or Pennsylvania for either a psychiatric condition or a general medical care condition. For Aim 4, we are completing qualitative interviews with directors of hospitals' clinical programs. This study is timely and significant because it will provide some of the first estimates of the impacts of population-based hospital system financing with strict budgetary controls on care coordination and integration for individuals with complex mental health conditions. The proposed study is both timely and innovative because its results will inform policymakers' assessments of how similar reforms are likely to affect the quality and value of hospital care for individuals with chronic mental illness and one or more co-occurring chronic medical problems.