Rural Health Clinics in Accountable Care Organizations: Impact on Disparities

描述（由申请人提供）：拟议的纵向研究调查了美国南部地区农村卫生诊所（RHCs）为老年人提供的护理，以及该护理的成本。问责医疗组织（ACOs）为基层医疗服务提供者提供了潜在的机会，尽管农村地区对ACOs的参与存在一些限制。然而，对于ACO模型如何适应RHC的独特挑战，以及RHC参与对农村老年人（包括少数群体）健康差异的影响，人们知之甚少。研究的具体目的是：1)分析和描述RHC参与ACOs的程度，以及选择参与ACOs的RHC的特征；2)分析农村社区卫生服务中心服务人群参与ACO及影响健康差异的其他因素；3)分析参与ACO等影响RHC老年患者成本效率和预防保健效果的因素。主要的研究假设是：1)与独立的健康护理中心相比，以提供者为基础的健康护理中心参与健康护理组织的比例更高；2)网络中的rhc比非网络中的rhc更有可能参与ACOs；3)大型rhc比小型rhc更有可能参与aco；4)在控制了环境因素的影响后，农村老年患者参与乡村社区服务与减少差异呈正相关；5) RHC参与ACOs与护理实践质量呈正相关，控制了环境的影响

DESCRIPTION (provided by applicant): The proposed longitudinal study investigates the care provided by Rural Health Clinics (RHCs) to older adults in the Southern region of the U.S., as well as the costs of that care. Accountable Care Organizations (ACOs) offer potential opportunities to RHCs despite several rural constraints to ACO participation. However, little is known about how the ACO model accommodates the unique challenges of RHCs, and the impact of RHC participation on the health disparities of rural older adults including those of minority groups. The specific aims of the study are: 1) to analyze and describe the extent of RHC participation in ACOs, and the characteristics of RHCs that choose to participate in ACOs; 2) to analyze ACO participation and other factors that impact health disparities of rural populations served by RHCs; and 3) to analyze ACO participation and other factors that impact cost efficiency and preventive care effectiveness for RHC older adult patients. The major research hypotheses are: 1) A higher percentage of provider-based RHCs will participate in ACOs compared to independent RHCs; 2) RHCs in networks will be more likely to participate in ACOs than unaffiliated RHCs; 3) Large RHCs are more likely to participate in ACOs than small RHCs; 4) RHC participation in ACOs is positively related to reduction of disparities of older adult rural patients, controlling for the effects of contextual factors; 5) RHC participation in ACOs is positively related to quality of care practices, controlling for the effects of contextual factors (such as ethnic/racial distribution and rurality); 6) RHC participation in ACOs is positively related to health outcomes of older adult rural patients, controlling for the effects o contextual factors (such as ethnic/racial distribution and rurality); and 7) RHC participation in ACOs will have a positive impact on cost efficiency and preventive care effectiveness. We will triangulate our analyses by using both quantitative and qualitative research methods including analysis of secondary data, survey research, and case studies. Multivariate analyses of seven years of organizational and community-related data of a panel of approximately 800 RHCs will be performed in order to develop more generalizable ideas about the factors contributing to RHC performance and outcomes. PUBLIC HEALTH RELEVANCE: Rural Health Clinics (RHCs) face numerous challenges such as serving communities with higher rates of chronic disease compared to urban communities, & attracting & retaining qualified professional staff. In analyzing how RHCs' participation in Accountable Care Organizations affects their performance, this study will assist policy leaders in making decisions that will strengthen the health care safety net in rural America.