Understanding Frequent EMS Users in the D.C. Health Care System: Evidence from Medicaid Claims Data

项目摘要 紧急医疗服务（EMS）的频繁用户或EMS“超级用户”给当地EMS带来了负担 系统和更广泛的医疗保健系统，导致急诊科（艾德）过度拥挤， 医院使用效率低下。由于现有国家一级数据来源的局限性以及 在地方和国家一级的EMS系统的异质性，EMS的使用是一个研究不足的健康领域， 服务文学。目前的知识是有限的，理解的背景下，艾德和住院病人的利用。 应用行为生态学框架，这项创新的多方法研究旨在提供一个改进的 了解频繁使用EMS和更广泛的医疗保健系统之间的关系。在这样做时， 研究小组希望能够确定可能导致减少频繁使用EMS的特定环境因素 使用，更合理地利用医疗资源，降低成本。核心假设是， 在医疗保健资源的使用，成本和门诊网络连接的实质性变化有关的具体 EMS超级用户群体的特征和EMS频繁使用的纵向模式。这项研究将 使用来自哥伦比亚特区（DC）的6年（2014 -19财年）的Medicaid索赔数据， 选择它的人均EMS呼叫量高和低未投保率。个人特征、保健 成人EMS用户的利用率和医疗补助费用将使用去识别的回归分析进行评估。 索赔数据（目标1和2）。将使用网络分析探讨门诊提供者网络连接 方法适用于索赔衍生的共享患者提供者网络（目标3）。这项研究尤其 这是及时的，因为《平价医疗法案》鼓励对创新的支付和服务提供进行测试 模式，如移动的综合健康社区护理，替代目的地计划，以及 与全国各地的EMS机构合作。预计研究结果将提供可操作的背景- 具体的见解，可以指导医疗补助驱动的努力，以提高护理效率的EMS超级用户在城市 设置.此外，这项研究将提供一个有用的例子，说明不同的方法如何适用于行政管理。 索赔数据可用于促进人口健康。这项研究建立在PI的方法培训的基础上， 研究和专业经验，在照顾协调弱势群体，是一个合作 DC的医疗补助机构和消防/EMS部门之间的努力。在研究团队专业知识的支持下， 在卫生经济学，卫生服务研究，计量经济学，网络分析，以及经验， 与EMS、医院、门诊医疗保健系统和社区合作伙伴合作，拟议的研究将 帮助推进PI的职业目标，即作为一个独立的卫生服务机构，弥合研究与实践之间的鸿沟 研究员

PROJECT ABSTRACT Frequent users of emergency medical services (EMS), or EMS “super-users”, present a burden to local EMS systems and the broader health care system by contributing to emergency department (ED) overcrowding and inefficient hospital use. Due to limitations in existing national-level data sources and the high level of heterogeneity in local- and state-level EMS systems, EMS use is an under-researched area of the health services literature. Current knowledge is limited and understood in the context of ED and inpatient utilization. Applying a behavioral-ecological framework, this innovative multi-methods study seeks to provide an improved understanding of the relationship between frequent EMS use and the broader health care system. In doing so, the study team hopes to identify possible context-specific factors that could lead to reductions in frequent EMS use, more appropriate use of health care resources, and lower costs. The central hypothesis is that there is substantial variation in health care resource use, costs, and outpatient network connectivity relating to specific characteristics of the EMS super-user population and longitudinal patterns of frequent EMS use. The study will use Medicaid claims data over a 6-year period (FY2014-19) from the District of Columbia (DC), which is chosen for its high per-capita EMS call volume and low uninsured rate. Individual characteristics, health care utilization, and Medicaid costs for adult EMS users will be assessed using regression analyses of de-identified claims data (Aims 1 and 2). Outpatient provider network connectivity will be explored using a network analysis approach applied to claims-derived shared-patient provider networks (Aim 3). This research is especially timely, since the Affordable Care Act has encouraged the testing of innovative payment and service-delivery models, such as Mobile Integrated Health-Community Paramedicine, alternative destination programs, and collaborations at various EMS agencies nationwide. Study findings are expected to provide actionable, context- specific insights that can guide Medicaid-driven efforts to improve care efficiency for EMS super-users in urban settings. Further, the study will provide a useful example of how disparate methods applied to administrative claims data can be leveraged to promote population health. The study builds on the PI's methods training, research, and professional experience in care coordination for vulnerable populations, and is a collaborative effort between DC’s Medicaid agency and Fire/EMS Department. Supported by the research team’s expertise in health economics, health services research, econometrics, network analysis, as well as experience in working with EMS, hospital, outpatient health care systems, and community partners, the proposed study will help advance the PI's career goal of bridging the research-practice divide as an independent health services researcher.