FINANCIAL INCENTIVES & CARE OF CHRONIC CARDIAC PATIENTS

本申请是对AHCPR RFA HS-98-005的响应。它将使用 目前正在收集有关已建立的临床表现的数据 针对急性心肌梗死(AMI)患者的措施， 充血性心力衰竭(CHF)或高血压。因为我们有能力 使用这些及时收集的临床表现数据作为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。研究中的患者在四种健康中的一种中得到了护理 六年计划(Allina、PacifiCare、Prudential和United Health Care) 97财年的不同站点。许多业绩衡量标准都在 HEDIS测试、报告或(2000年)可能的数据集。他们中的大多数 包括门诊护理，但也有一些是基于医院护理的。 通过对医务总监和医务管理人员的调查 我们将在上述数据中添加有关财务的信息 在护理期间有效的激励措施和管理做法 这项研究中的患者。我们将开发一种方法来 描述和理解财务激励的影响 和某些管理策略(信息反馈和使用 临床团队和具体管理计划) 相关的临床表现衡量标准。我们将关注临床 五个领域的业绩衡量(适当的药物治疗、医疗 关于风险调整、适当的诊断性测试、 患者的一般信息，以及对医疗的遵从性 建议)。最后，我们将把这些激励和管理联系起来 对可用的临床表现数据的策略以确定 它们在多大程度上影响护理模式。

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.