Designing policies to incentivize high-quality health care for vulnerable Americans: Evidence from the 340B Drug Pricing Program

项目摘要/摘要 苏尼塔·德赛博士的长期目标是提供政策信息，支持和激励提供商投资于 为弱势群体提供高质量的护理和机会。 这项提案是实现德赛博士长期目标的第一步，它将研究这样一个 政策，340B药品定价计划，将财政资源引导到符合条件的医院和他们的 门诊服务于不成比例的低收入人群。拟议的研究将 提供新的证据，说明该计划是否实现了提高临床质量的预期目标 和弱势患者的药物结果和/或对药物供应造成了意外的溢出效应 并向私人保险的人支出。 德赛博士是纽约大学医学院人口健康系的助理教授。她 拥有华盛顿大学沃顿商学院医疗保健管理和经济学博士学位 曾在宾夕法尼亚州哈佛大学卫生保健政策系担任塞德曼研究员 医学院。她受过医疗保健经济学、准实验研究方法和 使用大型管理数据集进行二次数据分析。德赛博士试图补充她的背景 卫生保健经济学和量化方法以及临床质量和药物结果方面的培训 衡量方法、弱势人群未得到满足的保健需求以及定性方法。这次培训 将使德赛博士有能力研究临床细微差别和特定人群的测量方法，并利用 用定性的方法通知定量的询问。 本提案的目的是(1)评估参与340B计划对医院质量的影响 护理未参保和医疗补助的患者，(2)评估医院340B参与对药物的影响 在低收入和私人保险人群中使用和遵守，以及(3)确定障碍和 促进者使医院有效地参与340B计划，符合政策目标。 这项建议明确回应了AHRQ对医疗保健系统中激励作用的强调 绩效(非HS-14-005)，重点关注AHRQ优先人群，包括低收入和未参保人群 病人。它将为340B计划对患者护理的影响产生新的和政策相关的证据 所有主要付款人群体和未参保者。结果还将为安全网医疗保健提供见解 更广泛的政策制定。该奖项将支持德赛博士向独立的过渡和她的长期 研究议程，为促进为大多数人提供可靠和高质量医疗保健系统的政策提供信息 脆弱的美国人。

PROJECT SUMMARY/ABSTRACT Dr. Sunita Desai’s long-term goal is to inform policies that support and incentivize providers to invest in high- quality care and access for vulnerable populations. This proposal, which is the first step in achieving Dr. Desai’s long-term goal, will study the impacts of one such policy, the 340B Drug Pricing Program, which directs financial resources to eligible hospitals and their outpatient practices serving disproportionate shares of low-income populations. The proposed research will generate novel evidence on whether the Program has achieved its intended goals of improving clinical quality and drug outcomes for vulnerable patients and/or has caused unintended spillover effects on drug provision and spending to the privately insured. Dr. Desai is an assistant professor in the Department of Population Health at NYU School of Medicine. She has a PhD in Health Care Management and Economics from The Wharton School of the University of Pennsylvania and was previously a Seidman Fellow in the Department of Health Care Policy at Harvard Medical School. She is trained in health care economics, quasi-experimental research methods, and secondary data analysis using large administrative datasets. Dr. Desai seeks to complement her background in health care economics and quantitative methods with training in clinical quality and drug outcomes measurement, the unmet health care needs of vulnerable populations, and qualitative methods. This training will give Dr. Desai the skills to study clinically-nuanced and population-specific measures and to leverage qualitative methods to inform quantitative inquiry. The aims of this proposal are (1) to estimate the impact of 340B Program participation on hospital quality of care for uninsured and Medicaid patients, (2) to assess the impact of hospital 340B participation on medication use and adherence among low-income and privately insured populations, and (3) to identify barriers and facilitators to effective hospital participation in the 340B Program consistent with the policy’s goals. This proposal explicitly addresses AHRQ’s emphasis on the role of incentives in health care system performance (NOT-HS-14-005), with a focus on AHRQ priority populations including low-income and uninsured patients. It will generate novel and policy-relevant evidence on the 340B Program’s effects on patient care across all major payer groups and the uninsured. Results will also yield insights for safety net health care policymaking more broadly. The award will support Dr. Desai’s transition to independence and her long-term research agenda to inform policies that promote a reliable and high-quality health care system for the most vulnerable Americans.