Association of Health Care Delivery and Payment Innovations with Avoidable Cardiovascular Hospitalizations

据估计，到2020年，美国每年因心血管疾病(CVD)而付出的代价将超过1.2万亿美元 2035年，心血管疾病住院费用推动了这一估计。[1]尽管预计会出现这种增长，但许多 如果患者得到适当和及时的门诊护理，心血管疾病的住院治疗可能是可以预防的。 医疗保健服务和支付改革可能在减缓这两个比率的预期上升方面发挥作用 目前尚不清楚心血管疾病住院和相关费用的多少。创新模式的例子 医疗保健交付和支付包括以患者为中心的医疗之家(PCMH)、共享储蓄 负责任的护理组织(ACO)、电子病历(EMR)的有意义的使用以及 区域卫生改善协作(RHIC)。这四种方法在 在过去十年里。例如，在2008至2014年间，全国医疗网站的数量从 214至6800人。在俄亥俄州，医疗网站的数量从2008年的零增加到2014年的520个。 快速增长，这四种方法对患者结局和医疗成本的影响存在不确定性 用于治疗心血管疾病。对于慢性疾病，如心血管疾病，这些方法很早就证明了 在一系列疾病管理指标上取得成功，如提供者经验、[3]患者 经验，[3-5]护理过程，[5，6]预防性护理利用，[7]和高成本护理利用。 以前关于这些模式对潜在可预防的心血管疾病住院的影响的研究主要集中在 每种方法都是单独的，没有解决相关的成本问题。此外，之前没有任何研究绘制出 这四种方法在医疗保健市场渗透率的演变。因此，是否和 这四种方法日益增长的医疗市场渗透率如何影响住院率和 心血管疾病的成本仍未得到回答。 这项建议的总体目标是用两个具体目标来解决这个问题：第一，量化 医疗保健市场渗透以患者为中心的医疗机构，共享储蓄和责任护理 组织、区域健康改善协作组和全州的电子病历 第二，对心血管疾病住院率的变化和变化之间的关系进行建模 医疗保健市场渗透率的四种方法中的每一种。成功的模型开发将增强 政策制定者将根据数据做出关于进一步实施和支持一体化 医疗保健提供和支付转型的模式，将有助于提高医疗质量和降低成本。

The annual cost of cardiovascular disease (CVD) in the United States is estimated to exceed $1.2 trillion by 2035, with the costs of CVD hospitalizations driving that estimate.[1] Despite this projected growth, many hospitalizations for CVD are potentially preventable if patients receive appropriate and timely ambulatory care. The role that healthcare delivery and payment reform may play in attenuating the expected rise in both the rate of CVD hospitalizations and associated costs is currently unknown. Examples of innovative models of healthcare delivery and payment include the patient centered medical home (PCMH), shared savings accountable care organizations (ACO), meaningful use of electronic medical records (EMR), and the presence of regional health improvement collaboratives (RHIC). These four approaches saw widespread adoption during the last decade. For example, between 2008 and 2014 the number of medical home sites rose nationally from 214 to 6,800. In Ohio, the number of medical home sites rose from zero in 2008 to 520 in 2014.[2] Despite this rapid growth, uncertainty exists about the effect of these four approaches on patient outcomes and cost of care for cardiovascular conditions. For chronic illnesses such as CVD, these approaches demonstrated early successes across a range of disease management indicators such as provider experience,[3] patient experience,[3-5] processes of care,[5, 6] preventive care utilization,[7] and high cost care utilization.[3] Importantly, prior studies of the effects of these paradigms on potentially preventable CVD hospitalization have focused on each approach individually and have not addressed associated costs. Moreover, no prior study has mapped the evolution of the healthcare market penetration of these four approaches. Thus the question of whether and how the growing healthcare market penetration of these four approaches affects the hospitalization rate and costs for CVD remains unanswered. The overall objective of this proposal is to address this question with two specific aims: first, to quantify the healthcare market penetration of patient centered medical homes, shared savings accountable care organizations, regional health improvement collaboratives, and electronic medical records throughout the state of Ohio; second, to model the relationship between changes in the rate of CVD hospitalization and changing healthcare market penetration of each of the four approaches. Successful model development will empower policy makers to make data-driven decisions regarding further implementation and support of integrated models of healthcare delivery and payment transformation that will help improve care quality and reduce costs.