RTI International, Research Triangle Park, North Carolina, USA.
Institute for Advanced Analytics, North Carolina State University, Raleigh, North Carolina, USA.
Health Serv Res. 2023 Dec;58(6):1266-1291. doi: 10.1111/1475-6773.14213. Epub 2023 Aug 9.
To evaluate whether primary care providers' participation in the Comprehensive Primary Care Plus Initiative (CPC+) was associated with changes in their delivery of high-value services.
Medicare Physician & Other Practitioners public use files from 2013 to 2019, 2017 to 2019 Medicare Part B claims for a 5% random sample of Medicare Fee-for-Service (FFS) beneficiaries, the Area Health Resources File, the National Plan & Provider Enumeration System files, and public use datasets from the Centers for Medicare & Medicaid Services Physician Compare.
We used a difference-in-difference approach with a propensity score-matched comparison group to estimate the association of CPC+ participation with the delivery of annual wellness visits (AWVs), advance care planning (ACP), flu shots, counseling to prevent tobacco use, and depression screening. These services are prominent examples of high-value services, providing benefits to patients at a reasonable cost. We examined both the likelihood of delivering these services within a year and the count of services delivered per 1000 Medicare FFS beneficiaries per year.
DATA COLLECTION/EXTRACTION METHODS: Secondary data are linked at the provider level.
We find that CPC+ participation was associated with increases in the likelihood of delivering AWVs (13.03 percentage points by CPC+'s third year, p < 0.001) and the number of AWVs per 1000 Medicare FFS beneficiaries (44 more AWVs by CPC+'s third year, p < 0.001). We also find that CPC+ participation was associated with more flu shots per 1000 beneficiaries (52 more shots by CPC+'s third year, p < 0.001) but not with the likelihood of delivering flu shots. We did not find consistent evidence for the association between CPC+ participation and ACP services, counseling to prevent tobacco use, or depression screening.
CPC+ participation was associated with increases in the delivery of AWVs and flu shots, but not other high-value services.
评估初级保健提供者参与综合初级保健加倡议（CPC+）是否与他们提供高价值服务的变化有关。
2013 年至 2019 年医疗保险医师和其他从业者公共使用文件，2017 年至 2019 年医疗保险 B 部分索赔的 5%随机样本，区域卫生资源文件，国家计划和提供者登记系统文件，以及医疗保险和医疗补助服务医师比较的公共使用数据集。
我们使用倾向评分匹配对照组的差异法来估计 CPC+参与与年度健康访视（AWV）、预先护理计划（ACP）、流感疫苗接种、预防烟草使用咨询和抑郁筛查的提供之间的关联。这些服务是高价值服务的突出例子，以合理的成本为患者提供益处。我们既检查了一年内提供这些服务的可能性，也检查了每年每 1000 名医疗保险 FFS 受益人的服务数量。
数据收集/提取方法：二级数据在提供者层面上进行链接。
我们发现，CPC+参与与提供 AWV 的可能性增加有关（CPC+第三年增加 13.03 个百分点，p<0.001）和每年每 1000 名医疗保险 FFS 受益人的 AWV 数量（CPC+第三年增加 44 次 AWV，p<0.001）。我们还发现，CPC+参与与每 1000 名受益人更多的流感疫苗接种有关（CPC+第三年增加 52 次疫苗接种，p<0.001），但与流感疫苗接种的可能性无关。我们没有发现 CPC+参与与 ACP 服务、预防烟草使用咨询或抑郁筛查之间关联的一致证据。
CPC+参与与 AWV 和流感疫苗接种的增加有关，但与其他高价值服务无关。
