The Impact of Accountable Care Organizations on Post Acute Care

项目摘要 冠状病毒大流行的到来对医疗保健系统产生了巨大而突然的影响。在 除了与冠状病毒和确诊为COVID-19的人直接相关的医疗资源外， 许多医院已经减少了他们提供的非紧急护理，许多病人已经减少了他们的 急诊科（艾德）因担心传染和冠状病毒的存在而就诊和住院 在疗养院和其他康复设施中，减少了获得急性后护理的机会。对于许多高风险 医疗保险受益人（最老年龄组，痴呆症患者，患有一种或多种慢性 条件下，透析或免疫功能低下，如接受化疗），这些减少可能是 一旦大流行压力下降，导致额外的艾德就诊、住院和急性期后护理，以及 对于一些人来说，延迟会增加他们病情的严重性，使他们的治疗更加困难和消极。 影响其临床结果。2012年推出的责任关怀组织（ACO），旨在激励 提供协调的高质量护理，已迅速增长，截至2020年1月，估计有11.2 传统的医疗保险按服务收费（FFS）受益人的26%。我们的目标是创造 初级保健医生团体，与医院和其他医疗保健提供者一起， 协调护理，减少低价值护理，以提高护理质量，同时降低成本。这 该提案旨在提供医疗服务利用模式的快速证据，以及一些重要的 诊断为COVID-19的Medicare FFS受益人的临床结果，以及使用和 诊断为COVID-19的患者的结局，特别关注艾德、住院和急性期后 护理，以及被分配到ACO是否具有保护作用。拟议的研究将把助理文书主任办公室 2019 - 2020年的参与数据、医疗保险索赔数据以及SNF、IRF和HHA评估数据， 进行差异中差异分析，检查COVID-19对住院和PAC的影响 利用和调解效果的行政长官通过追求以下具体目标：1。描述变化 艾德、住院、ICU和机械通气使用，确诊和未确诊的患者在大流行前/后 被诊断为COVID-19，以及ACO分配状态。2.描述PAC可用性的变化， COVID-19设施爆发和区域患病率，以及ACO医院转诊至PAC模式的变化 和非ACO受益人和提供者。3.描述SNF、IRF和HHA提供商的特征， 最大的变化在PAC的规定，和4。记录PAC治疗事件和患者结局的变更 PAC出院后，包括再次入院、成功出院至社区、功能恢复 确诊和未确诊COVID-19患者的改善率和死亡率，以及ACO status.这项研究的预期成果是及时了解对COVID-19的影响 PAC的利用和结果，以及与ACO归因相关的差异。

PROJECT SUMMARY The arrival of corona virus pandemic has had a dramatic and sudden impact on the healthcare system. In addition to the healthcare resources directly linked to the corona virus and those diagnosed with COVID-19, many hospitals have reduced their provision of non-emergent care and many patients have reduced their emergency department (ED) visits and hospitalizations for fear of contagion, and the presence of coronavirus in nursing homes and other rehabilitation facilities has reduced access to post-acute care. For many high-risk Medicare beneficiaries (in the oldest age groups, those with dementia, those with one or more chronic conditions, on dialysis or immunocompromised like those receiving chemotherapy) these reductions are likely to result in additional ED visits, hospitalizations and post-acute care once the pandemic pressure declines, and for some the delay will increase the severity of their condition making their treatment harder and negatively impacting their clinical outcomes. Accountable Care Organizations (ACOs), introduced in 2012 to incentivize the provision of coordinated high-quality care, have rapidly grown and as of January 2020 an estimated 11.2 million (26%) of the traditional Medicare fee-for-service (FFS) beneficiaries. The intended goal was to create groups of primary care doctors that—together with hospitals and other health care providers—would improve the coordination of care and reduce low-value care to increase the quality of care while reducing costs. This proposal seeks to provide quick evidence of the patterns of healthcare services utilization and some important clinical outcomes of Medicare FFS beneficiaries diagnosed with COVID-19, and of changes in utilization and outcomes of those diagnosed with COVID-19, paying particular attention to ED, hospitalizations and post-acute care, and to whether being assigned to an ACO has a protective effect. The proposed study will link ACO participation data, Medicare claims data and SNF, IRF and HHA assessment data across 2019-2020 to conduct a difference-in-differences analysis that examines the impact of COVID-19 on hospitalization and PAC utilization and the mediating effect of ACOs by pursuing the following specific aims: 1. Describe changes in ED, hospitalizations, ICU and mechanical ventilation utilization, pre/post pandemic of those diagnosed and not diagnosed with COVID-19, and by ACO assignment status. 2. Describe changes in PAC availability due to COVID-19 facility outbreaks and regional prevalence, and changes in hospital referral to PAC patterns for ACO and non-ACO beneficiaries and providers. 3. Characterize the SNF, IRF and HHA providers that had the largest changes in provision of PAC, and 4. Document changes in PAC episodes of care and patient outcomes following PAC discharge, including hospital readmissions, successful discharge to community, functional improvement and mortality rates among those who are and are not diagnosed with COVID-19, and by ACO status. The expected outcome of this research is to provide a timely understanding of the impact on COVID-19 on PAC utilization and outcomes, and the differences associated with ACO attribution.