Integrated health systems, market concentration, and socioeconomic disparities in quality of care

项目摘要/摘要 处于社会经济光谱相反两端的美国人的预期寿命相差10到15岁。 社会经济地位和其他社会健康决定因素，如就业、稳定 住房和获得健康食品在很大程度上解释了这些差异。然而，大量研究也表明， 低收入患者在各种质量上都比高收入患者得到更差的医疗服务 措施。许多低SES患者接受资源较少的医生组织(POS)的护理 照顾有复杂健康和社会需要的病人，包括多学科护理团队和高级 健康信息技术，与为高收入患者提供服务的POS相比。同时，整合了 医疗系统，即同时拥有医院和POS的医疗保健组织，正在全国范围内扩张 潜在的深远的医疗保健提供方式的变化。医疗系统拥有的POS可能是 处于有利地位，可以通过获得资本来支持解决SDOH问题的计划 改善基础设施，更好地获得患者的专业护理，以及更好地协调 护理设置。然而，先前的研究表明，卫生系统拥有POS对以下方面的影响很小 质量，与更高的支出相关，并可能导致更糟糕的患者体验。目前还不清楚是否 治疗低SES患者的POS正在加入医疗系统，或者医疗系统所有权如何影响Low的护理 自闭症患者。这项研究的具体目的是：(1)评估保健系统所有权的趋势 服务于低SES的患者；(2)评估POS的卫生系统所有权对SES差异的影响 获得护理的机会和护理质量；(3)将所有权变化对SES差异的影响分解为 PO内和PO之间的影响；以及(4)确定卫生系统通过哪些机制拥有PO和 独立的POS实现了SES差距的缩小。这项拟议的研究建立在 作为AHRQ资助的卫生系统绩效卓越中心的一部分，调查人员 探讨了医院所有权变化对医疗质量的影响，以及种族和民族在医疗质量上的差异 卫生系统拥有的POS和独立POS之间的护理，以及通过以下方式实现临床集成的努力 安全网提供商。这项研究将为政策制定者提供有关潜在好处或 卫生系统拥有PO对脆弱人群的意外后果及其作用 医生市场集中度和其他市场特征解释了SES差异的趋势。 从30个POS及其社区合作伙伴收集的主要数据将确定POS 用于减少SES差异和确定卫生系统所有权的附加值。

Project Summary/Abstract Americans at opposite ends of the socioeconomic spectrum differ in life expectancy by 10 to 15 years. Socioeconomic status (SES) and other social determinants of health (SDOH), such as employment, stable housing, and access to healthy food, explain much of these differences. However, numerous studies also show that low-income patients receive worse medical care than high-income patients across a wide range of quality measures. Many low-SES patients receive care from physician organizations (POs) that have fewer resources to care for patients with complex health and social needs, including multidisciplinary care teams and advanced health information technology, compared with POs serving higher-income patients. Meanwhile, integrated health systems, health care organizations that own both hospitals and POs, are expanding across the country with potentially far-reaching changes in how medical care is delivered. POs owned by health systems may be well-positioned to support initiatives that address SDOH through access to capital that could support infrastructure improvements, better access to specialty care for their patients, and better coordination across care settings. However, prior studies have shown that health system-ownership of POs has little to no effect on quality, is associated with higher spending, and may lead to worse patient experiences. It is not known whether POs that treat low SES patients are joining health systems or how health system ownership affects care for low SES patients. The specific aims of this study are to: (1) assess trends in health system ownership of POs that serve patients with low SES; (2) assess the impact of health system ownership of POs on SES disparities in access to care and quality of care; (3) decompose the effects of ownership changes on SES disparities into within-PO and between-PO effects; and (4) identify mechanisms through which health system-owned POs and independent POs achieve reductions in SES disparities. The proposed study builds on research conducted by the investigators as part of an AHRQ-funded Center of Excellence on Health System Performance that explored the impact of hospital ownership changes on quality of care, racial and ethnic differences in quality of care between heath system-owned POs and independent POs, and efforts to achieve clinical integration by safety net providers. The study will provide policymakers with timely information about the potential benefits or unintended consequences for vulnerable populations of PO ownership by health systems and the role of physician market concentration and other market characteristics in explaining trends in SES disparities. Primary data collection from 30 POs and their community partners will identify the specific strategies that POs are using to reduce SES disparities and to determine the value added of health system ownership.