Department of Public Health, Weill Cornell Medical College, 402 E 67th St., New York, NY 10065, USA.
Health Serv Res. 2011 Oct;46(5):1436-51. doi: 10.1111/j.1475-6773.2011.01272.x. Epub 2011 May 24.
To design a bundled case rate for Collaborative Care for Depression (CCD) that aligns incentives with evidence-based depression care in primary care.
A clinical information system used by all care managers in a randomized controlled trial of CCD for older primary care patients.
We conducted an empirical investigation of factors accounting for variation in CCD resource use over time and across patients. CCD resource use at the patient-episode and patient-month levels was measured by number of care manager contacts and direct patient contact time and analyzed with count data (Poisson or negative binomial) models.
Episode-level resource use varies substantially with patient's time in the program. Monthly use declines sharply in the first 6 months regardless of treatment response or remission status, but it remains stable afterwards. An adjusted episode or monthly case rate design better matches payment with variation in resource use compared with a fixed design.
Our findings lend support to an episode payment adjusted by number of months receiving CCD and a monthly payment adjusted by the ordinal month. Nonpayment tools including program certification and performance evaluation and reward systems are needed to fully align incentives.
设计协同护理治疗抑郁症（CCD）的捆绑病例付费方案，使激励机制与初级保健中的循证抑郁症护理相协调。
在一项针对老年初级保健患者的 CCD 的随机对照试验中，所有护理经理使用的临床信息系统。
我们对导致 CCD 资源使用随时间和患者变化的因素进行了实证调查。通过护理经理的接触次数和直接与患者接触的时间，以患者-发病次数和患者-月为单位来衡量 CCD 资源的使用情况，并使用计数数据（泊松或负二项式）模型进行分析。
发病次数水平的资源使用随患者在项目中的时间而有很大差异。无论治疗反应或缓解状态如何，在最初的 6 个月内，每月的使用量都会急剧下降，但此后保持稳定。与固定设计相比，调整后的发病次数或每月病例付费设计更能使支付与资源使用的变化相匹配。
我们的研究结果为按接受 CCD 的月数调整的发病次数付费和按序月数调整的每月付费提供了支持。需要非支付工具，包括项目认证和绩效评估以及奖励系统，以充分调整激励机制。
