Institution: Palo Alto Medical Foundation Research Institute
Title: Resource Use and Efficiency in Episodes of Care
Principal Investigator: Hal S. Luft, Ph.D.
Duration: 7/1/08–9/30/09
Paragraph Summary: The researchers seek to examine some of the underlying assumptions of episode-based payments, which are hypothesized to encourage more clinically and economically efficient practices by primary care physicians (PCPs). Specifically, they will assess whether episode-based measures of resource use at the individual PCP level, rather than the physician group or medical staff level, are statistically reliable and appropriate. Using data from the Palo Alto Medical Foundation (PAMF), a large multi-specialty physician group that uses electronic medical records (EMRs), the researchers will examine whether some PCPs have practice patterns significantly more (or less) expensive than the average at either the episode level or with groups of acute or chronic episodes. If there is variation in PCP practice patterns, the researchers will explore the role of components, such as PCP office visits, referrals, imaging, lab tests, and drugs, in these differences. They will also study clinicians’ explanations for differences in practice patterns, such as unmeasured severity, location, or other factors. They will compare PAMF-based patterns of care with overall patterns at an episode level (but not physician level) from a large national data set. The objective of the study is to determine whether consistent styles of practice across PCPs within a large medical group can be detected, which would help inform policymakers about whether physician-oriented incentives are worth pursuing.
Institution: University of Minnesota
Title: Comparing the Cost-Effectiveness of Chronic Care between Medicare Advantage and FFS Medicare Beneficiaries
Principal Investigator: David J. Knutson
Duration: 7/1/08–12/31/10
Paragraph Summary: Researchers at the University of Minnesota will compare the technical efficiency of care—a measure that links resource inputs with quality outcomes—for chronically ill Medicare Advantage (MA) and fee-for-service (FFS) beneficiaries. MA health plans are viewed by some as providing an opportunity to improve care for beneficiaries with chronic illnesses. Because MA plans do not submit encounter data to CMS, however, it has not been possible to directly address whether MA plans are more efficient than traditional Medicare FFS plans in caring for these beneficiaries. In particular, the researchers will: 1) validate that the new HEDIS Relative Resource Use (RRU) measures can be applied to FFS; and 2) compare RRUs in FFS and MA plans within geographic areas. The objective of the project is to provide policymakers with more information about the factors that contribute to efficiency and to identify the relative strengths of MA and FFS for chronically ill beneficiaries.
Institution: Visiting Nurse Service of New York
Title: Promoting Readiness and Interest in Self Management
Principal Investigator: Penny H. Feldman, Ph.D.
Duration: 7/1/08–9/30/09
Paragraph Summary: The researchers will investigate how patient activation occurs and under what circumstances in a historically under-represented population — Black/African Americans — who suffer disproportionately high rates of chronic illness. Patient activation, or engaging patients in their care, can improve the quality of care and health outcomes for those living with chronic conditions. Specifically, the researchers will: 1) evaluate psycho-social and clinical/functional determinants that influence a change in patients’ activation levels over time; 2) examine patients’ perspectives on their involvement in their care; 3) investigate factors that may help or hinder home care nurses’ promotion of self management and patient engagement; and 4) provide recommendations to improve clinician education and patient interventions. The objective of the proposed project, funded under a special topic solicitation on consumer activation, is to promote patient-centered care by identifying and providing recommendations to overcome patient-related barriers to self-management and to cultivate facilitators of clinician involvement in promoting patient self care.
Institution: Center for the Advancement of Health
Title: Getting Tools Used: Lessons Learned from Successful Decision Support Tools Unrelated to Health Care
Principal Investigator: Jessie C. Gruman, Ph.D.
Duration: 7/1/08–6/30/09
Paragraph Summary: The researchers will develop case studies of four successful decision-support tools from the transportation, education, electronic, and nutrition industries in order to promote greater public demand and use of decision tools for health care. The case studies will focus on the development, marketing and dissemination of the representative tools and consider questions such as: 1) Who initiated development of the tool and why? 2) Who was the audience? 3) How was the benefit of the tool framed? 4) How did this tool become a household name? 5) What were the dissemination strategies? 6) How was it marketed? 7) How were the tool and the dissemination strategies modified over time? 8) What were the barriers to the tool’s acceptance? 9) What was the timeline leading to acceptance? 10) How has the tool influenced consumer choice over time? and 11) Why did similar attempts not succeed? The objective of this project, awarded under a special topic solicitation on consumer activation, is to help health care decision tool developers refine their approaches to development, dissemination, and promotion and to increase public use of these tools to make informed choices about health and health care.
