Accountable Care Organizations: Development, Taxonomy, Quality and Cost Effects

描述（由申请人提供）：问责医疗组织（ACOs）正在迅速发展，其目标是提高医疗质量和控制医疗成本。以往对蚁群的研究都是零零碎碎地进行的，主要依赖于个别蚁群试验、示范和实验的狭隘研究，或者依赖于蚁群尚未形成的前蚁群数据。卫生保健提供者和政策制定者缺乏对推动ACO发展的因素的理解，以及什么样的ACO结构和能力（单独或组合）对实现ACO目标很重要。这项研究将提供新的见解，可以在近期内对改进正在进行的ACO开发产生影响。鉴于其广泛的国家范围和使用前/后蚁群设计，拟议的研究填补了现有知识的许多空白。拟议研究的具体目标包括定量分析有利于全国ACO发展的驱动因素。制定参与医疗补助和医疗保险服务中心（CMS）医疗保险共享储蓄计划（MSSP）和先锋ACO计划的医院分类。最后，本研究将评估医院ACO结构和能力的变化对2008-2013年期间医疗保险患者的医院护理质量和成本变化的影响。首先，通过识别和全面搜索这些ACOs的信息，将开发一个新的数据库，包含所有参与联邦指定的CMS ACOs项目的现有医院。该研究的重点是医院，因为它们在护理的连续性和ACO的实施中发挥关键作用，以及对医院护理的质量和成本的持续关注。其次，将有利于ACO发展的外部（如社会、市场和地理）和内部（如医院组织）驱动因素联系起来并进行评估。后一种分析不仅将提供关于为什么特定医院参与ACO的见解，而且还可能提供关键信息，以解决将进行的纵向质量和成本分析中潜在的内生性问题。第三，利用聚类分析技术对参与CMS ACOs的医院进行系统分析，建立首个基于医院的ACOs分类法。第四，将对ACO前和ACO后时期的医院与非ACO医院的ACO措施进行比较，然后对医院参与ACO及其相关能力进行一系列分析。我们将与医疗保健成本和利用项目国家住院病人数据库（HCUP SID）联系起来，制定护理质量措施（基于住院病人死亡率、不良事件、可预防的住院治疗、30天再入院率和30天死亡率）以及与医疗保险患者住院费用相关的措施。最后，我们将估计多元差异中的差异和固定效应模型，以实现项目估算医院质量和成本结果变化的具体目标。

DESCRIPTION (provided by applicant): Accountable Care Organizations (ACOs) are rapidly developing and have the goals of improving quality of care and containing health care costs. Previous research on ACOs has been conducted piecemeal, relying mainly on narrow studies of individual ACO pilots, demonstrations, and experiments, or on pre-ACO data because ACO were not yet formed. Health care providers and policy makers lack understanding of what drives ACO development, and what kind of ACO structures and competencies (alone or in combination) are important for achieving ACO goals. This study will provide new insights that can have a near-term effect on refining ongoing ACO development. Given its broad national scope and use of a pre-/post-ACO design, the proposed study fills many gaps in existing knowledge. Specific aims for the proposed study include quantitative analyses of drivers conducive to ACO development across the country. Development of a taxonomy of hospitals participating in the Centers for Medicaid and Medicare Services (CMS) Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. Finally, the study will evaluate the effects of changes in hospital ACO structures and competencies on changes in hospital quality of care and costs for Medicare patients over the period 2008-2013. First, a novel database of all existing hospitals participating in the federally-designated CMS ACO programs will be developed by identifying and comprehensively searching for information on these ACOs. The study focuses on hospitals given their key role in the continuum of care and ACO implementation, as well as persistent concerns about the quality and costs of hospital care. Second, external (e.g., social, market, and geographic) and internal (e.g., hospital organizational) drivers conducive to ACO development will be linked in and evaluated. This latter analysis not only will provide insights on why particular hospitals are participating in ACO but also may provide information critical to addressing potential endogeneity issues in the longitudinal quality and cost analyses that will be conducted. Third, hospitals participating in CMS ACOs will be systematically analyzed through use of cluster analytic techniques to develop the first hospital-based ACO taxonomy. Fourth, a series of analyses of hospital involvement in ACOs and their related competencies will follow comparing hospitals in the pre-ACO and the post-ACO periods with ACO measures relative to non-ACO hospitals. We will link in Healthcare Cost and Utilization Project State Inpatient Databases (HCUP SID) to develop quality of care measures (based on inpatient mortality, adverse events, preventable hospitalizations, 30-day hospital readmissions, and 30-day mortality) and measures related to hospital costs for Medicare patients. Finally, we will estimate multivariate difference-in-difference and fixed effects models to achieve the specific aims of the project for estimating changes in hospital quality and cost outcomes.