The Effect of Value-based Payment on Heart Failure Quality of Care (Value-HF)

项目总结/摘要 心力衰竭每年导致超过80，000人死亡，花费300亿美元，但改善的治疗方法 生存和降低发病率方面没有得到充分利用。医疗质量不足和高成本引发了 开发基于价值的支付计划，如医疗保险的基于绩效的激励计划（MIPS）。 MIPS是美国最大的临床医生基于价值的支付计划。MIPS旨在 通过根据临床医生的表现改变临床医生的支付方式，提高护理质量，同时降低成本 在成本和质量方面。MIPS质量测量越来越关注患者报告的结果 (PRO)尽管PRO改善心力衰竭护理的证据有限，但仍有一些措施，包括心力衰竭。目的 1将是一项务实的单中心随机试验，评价PRO评估是否整合到 常规心力衰竭临床工作流程是可行的，并且在一年时改善了健康相关的生活质量。这 以患者为导向的试验将确定PRO评估的临床影响是否值得数据成本 收藏.目标2将评估MIPS的引入（2017年）与以下趋势之间的关联： 医疗保险心力衰竭护理：指南推荐的治疗使用、死亡率和费用。本研究将使用 多种分析方法和对照（VA和商业保险心力衰竭患者）， 对这些关联的可靠估计。这项工作将对心力衰竭临床护理产生实质性影响 通过定义常规PRO评估和MIPS作为一个整体的效果来评估患者的预后。它将 为未来临床医生基于价值的支付模式的设计提供信息。Sandhu博士将沿着使用这项研究， 受保护的时间，培训，和指导这个K23奖，成为一个独立的，以病人为导向的 卫生服务研究员。Sandhu博士的长期研究目标是提高 通过评估当地质量改进和国家卫生的实施情况，对心力衰竭患者进行护理 政策拟议的研究经验和临床试验和因果推断统计方面的培训 在这个奖项是实现这些目标的关键。他将通过课程学习获得这些技能， 研究研讨会，全国会议，并从他的导师团队的直接指示。他的导师是 实施试验、结果分析和先进统计方法方面的专家。他们补充说， 拥有一个在临床试验、心力衰竭和健康方面具有互补专业知识的卓越咨询委员会， 政策有了这个导师团队和斯坦福大学医学系的支持，Sandhu博士将 有效完成目标1中试验的工具。他严格的训练计划，他导师的专业知识， 他对数据的经验使目标2中复杂的政策分析变得可行。总的来说，培训， 研究，并指导这个奖项将引导博士桑德胡在他的过渡，成为一个独立的， 成功的以病人为导向的卫生服务研究人员的技能，以竞争R级资金。

PROJECT SUMMARY/ABSTRACT Heart failure causes over 80,000 deaths and $30 billion in spending annually, yet therapies that improve survival and reduce morbidity are underutilized. Insufficient healthcare quality and high costs sparked the development of value-based payment programs, such as Medicare’s Merit-based Incentive Program (MIPS). MIPS is the largest clinician value-based payment program in use in the United States. MIPS is intended to improve the quality of care while reducing costs by altering clinician payments based on clinician performance on cost and quality measures. MIPS quality measurement is increasing its focus on patient-reported outcome (PRO) measures, including for heart failure, despite limited evidence that PROs improve heart failure care. Aim 1 will be a pragmatic, single-center randomized trial evaluating whether integration of PRO assessment into the routine heart failure clinic workflow is feasible and improves health-related quality of life at one year. This patient-oriented trial will determine if the clinical impact of PRO assessment is worth the costs of data collection. Aim 2 will evaluate the association between the introduction of MIPS (in 2017) and trends in Medicare heart failure care: guideline-recommended therapy use, mortality, and costs. This study will use multiple analytic approaches and controls (VA and commercially insured heart failure patients) to develop robust estimates of these associations. This work will have a substantial impact on heart failure clinical care and patient outcomes by defining the effect of both routine PRO assessment and MIPS as a whole. It will inform the design of future clinician value-based payment models. Dr. Sandhu will use this research along with the protected time, training, and mentorship of this K23 Award to become an independent, patient-oriented health services researcher. Dr. Sandhu’s long-term research goals are to improve the quality and efficiency of heart failure patient care by evaluating the implementation of local quality improvement and national health policy. The proposed research experience and the training in clinical trials and causal inference statistics during this award is critical to achieving those goals. He will gain these skills through coursework, local research seminars, national conferences, and direct instruction from his mentorship team. His mentors are experts in implementation trials, outcomes analysis, and advanced statistical methods. They are supplemented with an exceptional advisory committee with complementary expertise in clinical trials, heart failure, and health policy. With this mentorship team and support from the Stanford Department of Medicine, Dr. Sandhu will have the tools to efficiently complete the trial in Aim 1. His rigorous training plan, the expertise of his mentors, and his experience with the data make the sophisticated policy analysis in Aim 2 feasible. Overall, the training, research, and mentorship of this award will guide Dr. Sandhu in his transition to becoming an independent, successful patient-oriented health services researcher with the skills to compete for R-level funding.