University of California, San Francisco, San Francisco, California, USA.
University of Michigan, Ann Arbor, Michigan, USA.
Health Serv Res. 2022 Feb;57(1):47-55. doi: 10.1111/1475-6773.13646. Epub 2021 Feb 28.
To assess longitudinal primary care organization participation patterns in large-scale reform programs and identify organizational characteristics associated with multiprogram participation.
Secondary data analysis of national program participation data over an eight-year period (2009-2016).
We conducted a retrospective, observational study by creating a unique set of data linkages (including Medicare and Medicaid Meaningful Use and Medicare Shared Savings Program Accountable Care Organization (MSSP ACO) participation from CMS, Patient-Centered Medical Home (PCMH) participation from the National Committee for Quality Assurance, and organizational characteristics) to measure longitudinal participation and identify what types of organizations participate in one or more of these reform programs. We used multivariate models to identify organizational characteristics that differentiate those that participate in none, one, or two-to-three programs.
We used Medicare claims to identify organizations that delivered primary care services (n = 56 ,287) and then linked organizations to program participation data and characteristics.
No program achieved more than 50% participation across the 56,287 organizations in a given year, and participation levels flattened or decreased in later years. 36% of organizations did not participate in any program over the eight-year study period; 50% participated in one; 13% in two; and 1% in all three. 14.31% of organizations participated in five or more years of Meaningful Use while 3.84% of organizations participated in five years of the MSSP ACO Program and 0.64% participated in at least five years of PCMH. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs.
Primary care transformation via use of voluntary programs, each with their own participation requirements and approach to incentives, has failed to broadly engage primary care organizations. Those that have chosen to participate in multiple programs are likely those already providing high-quality care.
评估大规模改革计划中初级保健组织的参与模式，并确定与多项目参与相关的组织特征。
对八年（2009-2016 年）期间国家计划参与数据的二次数据分析。
我们通过创建一套独特的数据链接（包括 CMS 的医疗保险和医疗补助意义使用和医疗保险共享储蓄计划管理式医疗组织（MSSP ACO）参与、全国质量保证委员会的患者为中心的医疗之家（PCMH）参与和组织特征）进行回顾性观察研究，以衡量纵向参与情况，并确定哪些类型的组织参与了一个或多个这些改革计划。我们使用多元模型来确定区分那些不参与、参与一个或两个至三个计划的组织特征。
我们使用医疗保险索赔来确定提供初级保健服务的组织（n=56287），然后将组织与计划参与数据和特征联系起来。
在给定的一年中，没有一个计划在 56287 个组织中的参与率超过 50%，而且参与水平在后期趋于平稳或下降。在八年的研究期间，36%的组织没有参与任何计划；50%参与一个；13%参与两个；1%参与所有三个。14.31%的组织参与了五年或五年以上的有意义使用，而 3.84%的组织参与了五年的 MSSP ACO 计划，0.64%的组织参与了至少五年的 PCMH。较大的组织、年轻的提供者较多的组织、初级保健提供者较多的组织和 Medicare 患者群体较大的组织更有可能参与更多的项目。
通过使用具有各自参与要求和激励方法的自愿计划进行初级保健转型，未能广泛吸引初级保健组织。那些选择参与多个项目的人可能是那些已经提供高质量护理的人。
