"G-code" Reimbursement and Outcomes in Hemodialysis

描述(由申请者提供)：该项目将结合肾病学和卫生经济学的学科，研究肾科医生更频繁地为终末期肾病(ESRD)患者就诊的经济激励措施，如医疗保险和医疗补助服务中心于2004年1月通过医生报销的“G代码”创建的，如何影响患者的结果。我推测，引入“G代码”后，医疗保健提供者面对面就诊的频率增加，导致受“G代码”影响的医生治疗的终末期肾病患者的健康结果发生了变化。这项研究培训计划将为我提供作为一名内科科学家的职业背景，研究经济激励如何改善与患者相关的结果，并导致对肾病患者进行更具成本效益的护理。随着肾脏疾病变得越来越普遍，了解经济激励如何影响肾病患者的护理非常重要，因为美国政府制定的政策在很大程度上支配着终末期肾脏疾病治疗的经济激励。政府政策对ESRD患者治疗的经济激励有如此重大的影响，因为绝大多数ESRD患者主要由医疗保险覆盖。1虽然政府过去曾努力改变治疗ESRD患者的经济激励，并继续提出对经济激励的额外改变，但尚不确定这些经济激励的变化是否会影响患者的结果。在调查一项名为“G-CODE”的政府政策对终末期肾病患者健康结局的影响时，我将与卫生服务研究和肾脏病部门的导师合作，并将获得卫生服务研究硕士学位。这将为我提供必要的背景知识，以便在未来从事卫生经济学和成果研究的同时，开展关于“G代码”的拟议研究。 与公共健康相关：从公共健康的角度来看，了解经济激励如何影响肾脏疾病患者的治疗非常重要，因为肾脏疾病很常见，而且经常与其他常见疾病共存，如心血管疾病、糖尿病和高血压。肾脏疾病对老年人和穷人等弱势群体的影响也不成比例。随着治疗肾脏疾病的成本持续增加，对经济激励的了解将在制定未来战略以改善肾脏疾病患者的医疗保健组织、提供、融资、利用、结果和有效性方面发挥重要作用。

DESCRIPTION (provided by applicant): This project will combine disciplines of nephrology and health economics to study how the economic incentive for nephrologists to see patients with end-stage renal disease (ESRD) more frequently, as created by the Centers for Medicare and Medicaid Services in January 2004 through "G-codes" for physician reimbursement, affected patient outcomes. I hypothesize that the increased frequency of face-to-face visits by healthcare providers following introduction of "G-codes" led to changes in health outcomes in patients with ESRD who are treated by physicians affected by "G-codes". This research training program will provide me to with the background for a career as a physician-scientist investigating how economic incentives can improve patient-related outcomes and lead to more cost-effective care of people with kidney disease. Understanding how economic incentives impact care of patients with kidney disease is important as kidney disease is becoming increasingly common and because policies put in place by the United States government largely govern the economic incentives for treatment of end-stage renal disease. Government policy has such a significant impact on economic incentives for treatment of patients with ESRD because a large majority of patients with ESRD are covered primarily by Medicare.1 While the government has made efforts in the past to alter economic incentives for treatment of patients with ESRD, and continues to propose additional changes to economic incentives, it is not certain whether these changes in economic incentives affect patient outcomes. While investigating the affect that one government policy, "G-codes," have had on health outcomes in patients with end-stage renal disease, I will collaborate with mentors within the departments of Health Services Research and Nephrology, and will obtain a Masters Degree in Health Services Research. This will provide me with the background necessary to conduct the proposed research on "G-codes" in addition to a future career in health economics and outcomes research. PUBLIC HEALTH RELEVANCE: Understanding how economic incentives impact treatment of patients with kidney disease is important from a public health perspective because kidney disease is common and frequently co-exists with other common conditions such as cardiovascular disease, diabetes, and hypertension. Kidney disease also disproportionately affects vulnerable populations such as the elderly and poor. As the cost of treating kidney disease continues to increase, an understanding of economic incentives will play a major role in developing future strategies to improve in healthcare organization, delivery, financing, utilization, outcomes and effectiveness in patients with kidney disease.