Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, United States.
Center for Healthcare Organizations and Implementation Research, US Department of Veterans Affairs, Boston, MA, United States.
Front Public Health. 2021 Apr 6;9:645665. doi: 10.3389/fpubh.2021.645665. eCollection 2021.
Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs' impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs. The study's four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research's (CFIR) serves as the study's conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations). Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs. IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership.
马萨诸塞州于 2018 年设立了 17 个新的医疗补助（Medicaid）责任制医疗组织（ACO）和 24 个附属社区合作伙伴（CP），作为大规模医疗改革努力的一部分，以提高医疗保健的价值。新的 ACO 将通过交付系统改革激励计划（DSRIP）在 5 年内获得 18 亿美元的州和联邦资金。本研究方案中描述的多方面研究旨在通过确定实施和维持 DSRIP 资助计划的障碍和促进因素，解决有关医疗补助 ACO 对医疗保健价值影响的知识空白。该研究有四个组成部分：（1）文件审查，以描述 ACO 和 CP；（2）对 ACO 和 CP 领导层、州级医疗补助管理人员和患者进行半结构化关键知情人访谈（KII）；（3）对选定的 ACO 和 CP 进行现场访问；（4）对 ACO 临床团队和 CP 工作人员进行调查。综合实施研究框架（CFIR）作为该研究的概念框架；其灵活的菜单构建，分为五个领域（干预特性、内部环境、外部环境、个体特征和过程），指导在多个组织环境中识别障碍和促进因素。例如，KII 访谈指南侧重于了解内部和外部环境因素如何影响实施。文件审查分析包括提取和综合 ACO 特定的 DSRIP 资助计划（即干预特性）；KII 和现场访问数据将使用主题分析技术进行定性分析；调查将使用描述性统计（例如，计数、频率、平均值和标准差）进行分析。了解实施和维持具有不同组织结构的医疗补助 ACO 的障碍和促进因素，将为了解马萨诸塞州医疗补助 ACO 实验的总体影响提供关键背景。这也将为其他考虑将 ACO 模式应用于其医疗补助计划的州提供重要见解。IRB 的决定是，总体研究不构成人类受试者研究，并且每个主要数据收集阶段都应提交 IRB 审查和批准。研究结果将通过传统渠道传播，如同行评议的期刊，通过 mass.gov 网站上的公开报告；并直接传达给 ACO 和 CP 领导层的主要利益相关者。
