Value-based Purchasing in Implementation of Depression Care in Community Clinics

摘要 多达4000万低收入美国人将依靠社区卫生诊所（CHCs）提供初级保健， 2019.抑郁症和其他行为健康状况是疾病负担的主要来源， 人口实施循证行为保健是社区卫生中心的优先领域。的目标 本研究旨在评估基于价值的采购（VBP）的作用，这是一项政策战略， 在社区卫生中心实施循证护理。VBP是一种通过链接支付来刺激质量改进的工具 提供商组织预先指定的性能目标。拟议的研究将利用一个独特的 由华盛顿州心理健康整合计划（MHIP）发起的VBP计划。MHIP工具 协作护理模式，一个突出的，以证据为基础的模式，将行为健康护理整合到 初级保健. MHIP的多相VBP嵌入了几个理想的设计功能，并提供了一个难得的机会， 就越南船民政策的成效提供概括性的研究结果，以支持推行以实证为本的 慢性病护理我们将根据MHIP登记和医疗保健对现有数据进行回顾性分析 来自华盛顿州国王县和皮尔斯县52个社区卫生中心的12,000多名患者提出索赔。宗旨 研究旨在评估MHIP VBP对以下方面的影响：1.社区保健中心采用协作保健; 2.患者 结果。我们将根据以下关键护理过程要素的CHC性能来衡量采用情况： 患者事件水平的协作护理。患者的结果包括抑郁症状， 住院、急诊室使用和医疗保健总费用。我们的分析策略将利用自然 通过将患者滚动入组MHIP创建的实验。具体来说，我们将比较结果 与VBP前、VBP中和VBP后发生的患者事件有关，同时控制持续的 社区卫生中心的学习和采用过程。初步数据显示，总体采用率较低， 随着时间的推移，以及CHC对VBP激励措施的行为反应与 拟议研究的概念框架。这项研究将产生重要的知识，以协助决策者 决定是否使用越南船民政策，以加强在社区医院推行循证护理，以及 如何最好地设计越南船民政策，以最大限度地发挥其影响。

ABSTRACT As many as 40 million low-income Americans will rely on community health clinics (CHCs) for primary care by 2019. Depression and other behavioral health conditions are a major source of disease burden in this population. Implementation of evidence-based behavioral health care is a priority area for CHCs. The goal of this study is to assess the role of Value-Based Purchasing (VBP), a policy strategy, to enhance planned implementation of evidence-based care in CHCs. VBP is a tool to spur quality improvement by linking payment to provider organizations with pre-specified performance targets. The proposed study will leverage a unique VBP program initiated by the Washington State Mental Health Integration Program (MHIP). MHIP implements the CollaborativeCare model, a prominent, evidence-based model to integrate behavioral health care into primary care. MHIP's multi-phase VBP embeds several desirable design features and offers a rare opportunity to produce generalizable findings on the effectiveness of VBP to support implementation of evidence-based chronic care. We will conduct retrospective analysis of existing data based on MHIP registry and health care claims of over 12,000 patients from 52 CHCs in Washington State's King and Pierce Counties. Aims of the study are to assess the effects of MHIP VBP on: 1. Adoption of CollaborativeCare by CHCs; and, 2. Patient outcomes. We will measure adoption based on CHC performance of key process-of-care elements of CollaborativeCare at the patient-episode level. Patient outcomes include depression symptoms, hospitalization, emergency room use and total health care costs. Our analytical strategy will exploit the natural experiment created by the rolling enrollment of patients into MHIP. Specifically, we will compare outcomes pertaining to patient-episodes that occurred pre-, peri-, and post- VBP while controlling for the continuous learning and adopting processes at CHCs. Preliminary data suggest overall low adoption pre-VBP, substantial improvement over time, and CHC behavioral responses to VBP incentives that are consistent with the conceptual framework of the proposed study. This study will generate critical knowledge to assist policymakers with their decisions on whether to use VBP to enhance implementation of evidence-based care in CHCs and how to best design VBP to maximize its impact.