Changes in Patients' Experiences in Medicare Accountable Care Organizations

被引：132
作者：
McWilliams, J. Michael [1 ,2 ,3 ]
Landon, Bruce E. [1 ,4 ]
Chernew, Michael E. [1 ]
Zaslavsky, Alan M. [1 ]
机构：
[1] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Dept Med, Div Gen Internal Med & Primary Care, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Boston, MA 02115 USA
[4] Beth Israel Deaconess Med Ctr, Dept Med, Div Gen Internal Med & Primary Care, Boston, MA 02215 USA
来源：
NEW ENGLAND JOURNAL OF MEDICINE | 2014年 / 371卷 / 18期
关键词：
MANAGED CARE; PERFORMANCE;
D O I：
10.1056/NEJMsa1406552
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
BACKGROUND Incentives for accountable care organizations (ACOs) to limit health care use and improve quality may enhance or hurt patients' experiences with care. METHODS Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data covering 3 years before and 1 year after the start of Medicare ACO contracts in 2012 as well as linked Medicare claims, we compared patients' experiences in a group of 32,334 fee-for-service beneficiaries attributed to ACOs (ACO group) with those in a group of 251,593 beneficiaries attributed to other providers (control group), before and after the start of ACO contracts. We used linear regression and a difference-in-differences analysis to estimate changes in patients' experiences in the ACO group that differed from concurrent changes in the control group, with adjustment for the sociodemographic and clinical characteristics of the patients. RESULTS After ACO contracts began, patients' reports of timely access to care and their primary physicians' being informed about specialty care differentially improved in the ACO group, as compared with the control group (P = 0.01 and P = 0.006, respectively), whereas patients' ratings of physicians, interactions with physicians, and overall care did not differentially change. Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group (P = 0.02). Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings) and were robust to adjustment for group differences in trends during the preintervention period. CONCLUSIONS In the first year, ACO contracts were associated with meaningful improvements in some measures of patients' experience and with unchanged performance in others.
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页码：1715 / 1724
页数：10
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