Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon, USA.
Prev Med. 2021 Apr;145:106405. doi: 10.1016/j.ypmed.2020.106405. Epub 2020 Dec 31.
Only half of the United States population regularly receives recommended preventive care services. Alternative payment models (e.g., a per-member-per-month capitated payment model) may encourage the delivery of preventive services when compared to a fee-for-service visitbased model; however, evaluation is lacking in the United States. This study assesses the impact of implementing Oregon's Alternative Payment Methodology (APM) on orders for preventive services within community health centers (CHCs). This retrospective cohort study uses electronic health record data from the OCHIN, Inc., 2012-2018, analyzed in 2018-2019. Twenty-seven CHCs which implemented APM in 2013-2016 were compared to six non-APM CHCs. Clinic-level quarterly rates of ordering nine preventive services in 2012-2018 were calculated. For each phase and preventive service, we used difference-in-differences analysis to assess the APM impact on ordering preventive care. We found greater increases for APM CHCs compared to non-APM CHCs for orders of mammograms (difference-in-differences estimates (DDs) across four phases:1.69-2.45). Both groups had decreases in ordering cervical cancer screenings, however, APM CHCs had smaller decreases (DDs:1.62-1.93). The APM CHCs had significantly greater decreases in influenza vaccinations (DDs:0.17-0.32). There were no consistent significant differences in pre-post changes in APM vs. non-APM CHCs for cardiometabolic risk screenings, smoking status and depression assessments. There was nonsignificant change in the proportion of nontraditional encounters in APM clinics compared to controls. Transition from fee-for-service to an APM did not negatively impact delivery of preventive care. Further studies are needed to understand how to change encounter structures to best deliver recommended preventive care.
只有一半的美国人口定期接受推荐的预防保健服务。与按服务收费的就诊模式相比，替代支付模式（如按人头按月付费模式）可能会鼓励提供预防服务；然而，美国对此缺乏评估。本研究评估了俄勒冈州替代支付方法（APM）对社区卫生中心（CHC）内预防服务订单的影响。这项回顾性队列研究使用了 OCHIN，Inc. 的电子健康记录数据，时间范围为 2012-2018 年，分析于 2018-2019 年进行。将 2013-2016 年实施 APM 的 27 个 CHC 与 6 个非 APM CHC 进行比较。计算了 2012-2018 年九个预防服务的季度订购率。对于每个阶段和预防服务，我们使用差异分析来评估 APM 对订购预防保健的影响。我们发现，与非 APM CHC 相比，APM CHC 的订购量有更大的增长，包括乳房 X 光检查（四个阶段的差异差异估计（DDs）：1.69-2.45）。两组都减少了宫颈癌筛查的订购，但 APM CHC 的减少幅度较小（DDs：1.62-1.93）。APM CHC 流感疫苗接种的降幅明显更大（DDs：0.17-0.32）。在 APM 与非 APM CHC 之间，心血管代谢风险筛查、吸烟状况和抑郁评估的前后变化没有一致的显著差异。与对照组相比，APM 诊所中非传统就诊的比例没有变化。从按服务收费向 APM 过渡并没有对预防保健的提供产生负面影响。需要进一步的研究来了解如何改变就诊结构，以最好地提供推荐的预防保健。
