Comparative effectiveness of the sequential implementation of Hospital Value-Based Purchasing

描述（由申请人提供）：尽管广泛使用财政激励措施来提高医疗保健的价值，但这些计划的有效性和意外后果仍不清楚。《患者保护和平价医疗法案》建立了医院基于价值的采购（HVBP），使医疗保险的支付取决于美国急性护理医院的质量表现。目前的项目的目标是应用计量经济学方法，纵向医疗保险数据和主要数据，从全国医院管理人员的调查，以估计HVBP的有效性和意外后果，在其实施的第一个五年。将处理以下三个目标：1）评估 医院价值采购的有效性。我们预计HVBP将改善临床过程性能和患者体验，但不会改善死亡率、患者安全性或护理成本。我们将使用计量经济学方法比较实施HVBP前后暴露于HVBP的医院和未暴露于HVBP的匹配医院之间研究结果的变化。2)评估医院基于价值的采购的意外后果。我们希望HVBP将奖励金从照顾弱势患者的医院中分配出去，但不会降低这些医院治疗患者的护理质量，也不会影响不受经济激励的cae领域的质量。3)了解医院价值采购中价值提升的障碍和促进因素。研究小组将进行一项全国性调查，以评估医院管理人员对HVBP的了解，对价值改进的成本和收益的看法，对意外后果的看法，对价值改进的障碍和促进因素的看法，以及用于HVBP价值改进的具体策略。我们将对比HVBP中高绩效医院和低绩效医院之间的调查响应。这项拟议的研究意义重大，因为它将提供关键信息，为正在实施的HVBP提供信息，以增加医疗保险的价值，同时最大限度地减少对医院和患者的意外后果。我们的研究是创新的，因为它将使用新的计量经济学方法，并将提供第一个调查结果，医院的反应，HVBP的激励措施。每年约有19万名因心脏病发作、心力衰竭或肺炎入院的医疗保险患者在入院后30天内死亡。如果30天死亡率降低1%，其中1,900名患者将在30天后存活。HVBP的这种潜在影响强调了了解如何最好地设计HVBP以改善护理的重要性。

DESCRIPTION (provided by applicant): Despite the widespread use of financial incentives to improve value in health care, the effectiveness and unintended consequences of these programs remains unclear. The Patient Protection and Affordable Care Act established Hospital Value-Based Purchasing (HVBP), making Medicare payment subject to quality performance for acute care Hospitals in the United States. The objective of the current project is to apply econometric methods to longitudinal Medicare data and primary data from a national survey of hospital administrators to estimate the effectiveness and unintended consequences of HVBP in its first five years of implementation. The following three aims will be addressed: 1) Evaluate the effectiveness of Hospital Value- Based Purchasing. We expect that HVBP will improve clinical process performance and patient experience but will not improve mortality, patient safety, or costs of care. We will use econometric methods to compare the changes in our study outcomes between hospitals that were exposed to HVBP and a matched set of hospitals that were not exposed to HVBP, before and after HVBP was implemented. 2) Evaluate the unintended consequences of Hospital Value-Based Purchasing. We expect that HVBP will distribute incentive payments away from hospitals caring for disadvantaged patients but will not decrease quality of care for patients treated in these hospitals and will not affect quality for areas of cae that are not subject to financial incentives. 3) Understand the barriers and facilitators to value improvement in Hospital Value-Based Purchasing. The study team will field a national survey to assess hospital administrators' knowledge of HVBP, perceptions of the costs and benefits of value improvement, perceptions of unintended consequences, perceptions of the barriers and facilitators to value improvement, and the specific strategies used for value improvement in HVBP. We will contrast survey responses between high and low performing hospitals in HVBP. The proposed research is significant because it will provide crucial information to inform the ongoing implementation HVBP to increase value for Medicare while minimizing unintended consequences for hospitals and patients. Our study is innovative because it will use novel econometric methods and will provide the first survey results about hospitals' response to the incentives of HVBP. Approximately 190,000 Medicare patients admitted to hospitals each year with heart attack, heart failure, or pneumonia die within 30 days of admission. A 1% reduction in 30- day mortality rates would leave 1,900 of these patients alive after 30 days. This potential impact of HVBP underscores the importance of understanding how HVBP can be best designed to improve care.