FINANCIAL INCENTIVES & CARE OF CHRONIC CARDIAC PATIENTS

本申请是对AHCPR RFA HS-98-005的回应。 它将使用 目前正在收集的已确立临床性能数据 急性心肌梗死（AMI）患者的措施， 充血性心力衰竭（CHF）或高血压。 因为我们能够 使用这些及时收集的临床性能数据，作为Q- SPAN，我们将节省大约25万美元， 作为RFA一部分的图表提取和患者调查的直接成本 98-005.研究中的患者在四个健康中心之一接受治疗。 计划（Allina，Pacificare，Prudential和United Health Care） 在CY 97的不同地点。 许多绩效指标都在 HEDIS测试、报告或可能（2000年）的数据集。 他们中的大多数 涉及门诊护理，但也有一些是以医院护理为基础的。 通过对医疗机构的医疗主任和管理人员的调查， 我们将在上述数据中增加有关财务状况的信息， 在护理期间有效的激励措施和管理做法 研究中的患者。 我们将制定一种方法， 描述和理解财务激励措施的影响 和某些管理战略（信息反馈和利用 临床团队和具体的管理计划）， 相关临床性能指标。 我们将着眼于临床 五个领域的业绩计量（适当的药物治疗、医疗 关于风险修正的建议，适当的诊断测试， 患者的一般信息，以及医疗依从性 建议）。 最后，我们将把这些激励措施和管理措施联系起来， 根据可用临床性能数据确定 它们对护理模式的影响程度。

This application is in response to AHCPR RFA HS-98-005. It will use data currently being collected on established clinical performance measures for patients with an acute myocardial infarction (AMI), congestive heart failure (CHF), or hypertension. Because we are able to use these timely clinical performance data collected as part of Q- SPAN, we will save approximately one quarter of a million dollars in direct costs for chart abstraction and patient surveys as part of RFA 98-005. The patients in the study were cared for in one of four Health Plans (Allina, Pacificare, Prudential and United Health Care) in six different sites in CY97. Many of the performance measures are in the HEDIS testing, reporting or likely (for 2000) data sets. Most of them involve ambulatory care, but a few are based on hospital care as well. Through surveys with medical directors and administrators of medical groups we will augment the above data with information on financial incentives and managerial practices that were operative during the care of the patients in the study. We will develop an approach for characterizing and understanding the influence of financial incentives and certain management strategies (information feedback and use of clinical teams and specific management programs) on clinical care and associated clinical performance measures. We will look at clinical performance measures in five areas (appropriate drug therapy, medical advice regarding risk modification, appropriate diagnostic tests, general information for the patient, and compliance with medical advice). Finally, we will then link these incentives and managerial strategies to the available clinical performance data to determine the extent to which they influence care patterns.