Competitive Bidding in Medicare and the Implications for Home Oxygen Therapy in COPD

项目摘要/摘要 慢性阻塞性肺疾病(COPD)是慢性阻塞性肺疾病中最大的疾病负担 美国的呼吸道疾病，影响了1600万美国人，导致15万人死亡 每年一次。家庭氧疗是COPD为数不多的降低死亡率的疗法之一。在过去十年里， 一项名为竞争性投标计划(CBP)的医疗保险政策显著改变了住房价格 氧气和为病人提供服务的供应商的数量。这项政策的效果还没有被研究过 广泛存在，目前尚不清楚。专业协会表达了对患者回家的担忧 氧气及其相关的临床益处受到了负面影响。另一方面，程序 联邦医疗保险的监测没有揭示CBP的任何意想不到的后果。 本研究提出采用准实验观察法和半结构法相结合的研究方法 独立、严谨地评估CBP对家庭供氧途径影响的定性访谈 以及慢性阻塞性肺疾病患者的临床结局。段博士将(1)评估CBP对获取 COPD患者的家庭氧气，(2)检查CBP和以患者为中心之间的联系 COPD患者的临床结果，以及(3)确定患者和提供者对其 目前家庭氧气处方的经验。这项提议将产生重要的政策和病人护理 有可能为CBP重新设计提供参考并为未来改进战略奠定基础的见解 家庭氧气护理。 通过这笔赠款，段医生作为一名早期职业研究人员和肺科医生，将接受高级 因果推理方法，用于政策研究的大型行政数据集的分析，以及定性 研究方法。拟议的研究和全面职业发展计划将为段博士做好准备 作为研究如何优化卫生系统和政策的独立调查员的职业生涯 改善呼吸健康，为患者创造价值。这些研究和培训活动将由 华盛顿大学学术丰富的研究环境中的专家导师团队 医学和公共卫生学院以及普吉特湾健康退伍军人事务部 护理系统。

PROJECT SUMMARY/ABSTRACT Chronic obstructive pulmonary disease (COPD) causes the largest burden of disease among chronic respiratory conditions in the United States, affecting 16 million Americans and leading to 150,000 deaths annually. Home oxygen therapy is one of few therapies in COPD that reduces mortality. Over the last decade, a Medicare policy, the Competitive Bidding Program (CBP), has significantly changed the price of home oxygen and the number of suppliers servicing patients. The effect of this policy has not been studied extensively and is currently unknown. Professional societies have voiced concern that patient access to home oxygen and its associated clinical benefits have been negatively affected. On the other hand, program monitoring by Medicare has not revealed any unintended consequences of the CBP. This mixed methods study proposes to use quasi-experimental observational methods and semi-structured qualitative interviews to independently and rigorously evaluate the effects of the CBP on home oxygen access and clinical outcomes among patients with COPD. Dr. Duan will (1) assess the effect of the CBP on access to home oxygen among patients with COPD, (2) examine the association between the CBP and patient-centered clinical outcomes among patients with COPD, and (3) identify patient and provider perspectives about their current experience with home oxygen prescribing. This proposal will generate important policy and patient care insights that have the potential to inform CBP redesign and lay the foundation for future strategies to improve home oxygen care. Through this grant, Dr. Duan, an early career investigator and pulmonologist, will receive training in advanced causal inference methods, the analysis of large administrative datasets for policy research, and qualitative research methods. The proposed research and comprehensive career development plan will prepare Dr. Duan for a career as an independent investigator studying how health systems and policies can be optimized to improve respiratory health and value for patients. These research and training activities will be supervised by an expert team of mentors at the academically rich research environments of the University of Washington Schools of Medicine and Public Health, as well as the Department of Veterans Affairs Puget Sound Health Care System.