Comparative effectiveness of the sequential implementation of Hospital Value-Based Purchasing

描述(由申请人提供)：尽管广泛使用财政激励来提高医疗保健的价值，但这些计划的有效性和意想不到的后果仍然不清楚。患者保护和平价医疗法案建立了基于医院价值的采购(HVBP)，使美国急性护理医院的医疗保险付款取决于质量表现。当前项目的目标是将计量经济学方法应用于纵向医疗保险数据和来自全国医院管理人员调查的原始数据，以评估HVBP在实施的头五年的有效性和意外后果。将实现以下三个目标：1)评估 医院价值采购的有效性。我们预计，HVBP将改善临床流程性能和患者体验，但不会改善死亡率、患者安全性或护理成本。我们将使用计量经济学方法，比较在实施HVBP前后，暴露于HVBP的医院和未暴露于HVBP的医院之间研究结果的变化。2)评估医院价值采购的意外后果。我们预计，HVBP将从照顾弱势患者的医院发放奖励款项，但不会降低在这些医院接受治疗的患者的护理质量，也不会影响不受经济激励的CAE地区的质量。3)了解医院价值采购中价值提升的障碍和促进者。研究小组将开展一项全国性调查，以评估医院管理者对HVBP的了解、对价值改进的成本和收益的看法、对意外后果的看法、对价值改进的障碍和促进者的看法，以及在HVBP中用于价值改进的具体战略。我们将对比高绩效医院和低绩效医院之间的调查结果。拟议的研究具有重要意义，因为它将提供关键信息，为正在实施的HVBP提供信息，以增加医疗保险的价值，同时将对医院和患者的意外后果降至最低。我们的研究具有创新性，因为它将使用新的计量经济学方法，并将提供关于医院对HVBP激励措施的反应的第一个调查结果。每年约有19万名因心脏病发作、心力衰竭或肺炎入院的医疗保险患者在入院后30天内死亡。30天死亡率降低1%将使其中1900名患者在30天后存活。HVBP的这一潜在影响突显了了解如何最好地设计HVBP以改善护理的重要性。

DESCRIPTION (provided by applicant): Despite the widespread use of financial incentives to improve value in health care, the effectiveness and unintended consequences of these programs remains unclear. The Patient Protection and Affordable Care Act established Hospital Value-Based Purchasing (HVBP), making Medicare payment subject to quality performance for acute care Hospitals in the United States. The objective of the current project is to apply econometric methods to longitudinal Medicare data and primary data from a national survey of hospital administrators to estimate the effectiveness and unintended consequences of HVBP in its first five years of implementation. The following three aims will be addressed: 1) Evaluate the effectiveness of Hospital Value- Based Purchasing. We expect that HVBP will improve clinical process performance and patient experience but will not improve mortality, patient safety, or costs of care. We will use econometric methods to compare the changes in our study outcomes between hospitals that were exposed to HVBP and a matched set of hospitals that were not exposed to HVBP, before and after HVBP was implemented. 2) Evaluate the unintended consequences of Hospital Value-Based Purchasing. We expect that HVBP will distribute incentive payments away from hospitals caring for disadvantaged patients but will not decrease quality of care for patients treated in these hospitals and will not affect quality for areas of cae that are not subject to financial incentives. 3) Understand the barriers and facilitators to value improvement in Hospital Value-Based Purchasing. The study team will field a national survey to assess hospital administrators' knowledge of HVBP, perceptions of the costs and benefits of value improvement, perceptions of unintended consequences, perceptions of the barriers and facilitators to value improvement, and the specific strategies used for value improvement in HVBP. We will contrast survey responses between high and low performing hospitals in HVBP. The proposed research is significant because it will provide crucial information to inform the ongoing implementation HVBP to increase value for Medicare while minimizing unintended consequences for hospitals and patients. Our study is innovative because it will use novel econometric methods and will provide the first survey results about hospitals' response to the incentives of HVBP. Approximately 190,000 Medicare patients admitted to hospitals each year with heart attack, heart failure, or pneumonia die within 30 days of admission. A 1% reduction in 30- day mortality rates would leave 1,900 of these patients alive after 30 days. This potential impact of HVBP underscores the importance of understanding how HVBP can be best designed to improve care.