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Persons with disabilities generating quality metrics to inform integrated care
Investigator (PI): Iezzoni, Lisa
Performing Organization (PO): (Current): Massachusetts General Hospital, Mongan Institute Health Policy Center / (617) 724-4744
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2018
Record Source/Award ID: PCORI/IHS-1306-01424
Funding: Total Award Amount: $2,019,733
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: On October 1, 2013, Massachusetts will launch One Care (OC), a demonstration project to provide integrated care, ranging from hospital and medical services to long-term services and supports in the community, to persons with disabilities ages 21 to 64 who are dually eligible for Medicare and Medicaid (MassHealth). Three managed care plans will offer OC in nine counties across Massachusetts, home to approximately 90,000 potential participants. The demonstration offers tremendous promise to improve the care and thus lives of persons with complex medical, behavioral, and functional needs. However, both Medicare and MassHealth payments to OC plans will be capitated: they will get a single lump sum for each enrollee. Massachusetts disability advocates therefore worry about incentives for skimping on care. To prevent this, two major Massachusetts disability advocacy groups formed Disability Health Alliance (DHA), with the mission of educating and engaging their constituents in monitoring OC quality. In close collaboration with DHA, this project aims to test a consumer-driven intervention: persons with significant physical disabilities or serious and persistent mental illness continually assessing their care and feeding back this information to the OC clinical practices overseeing their care. The three OC plans (Commonwealth Care Alliance, Fallon Total Care, and Network Health) will randomly select 12 of their OC clinical practices (or interdisciplinary clinical teams) to participate in the study. The study will randomly assign these 36 practices to three groups: (1) standard quality measurement required by Medicare and MassHealth; (2) standard measures + information from a new patient survey designed for this project (Persons with Disabilities Quality Survey or PDQ-S); or (3) standard measures + PDQ-S + real-time, continuous feedback of quality information by OC patients (Persons with Disabilities Quality Monitoring Intervention or PDQ-MI). PDQ-S design will start with specifying a quality framework for persons with disabilities and then identifying key quality metrics, drawing from 12 focus groups of English- and Spanish-speaking persons with physical or mental health disabilities organized through Consumer Quality Initiative, an advocacy group for persons with mental illness. We will survey 720 OC patients from the 36 practices, expecting that 60% will reply. The one-year PDQ-MI will involve intensive consumer education, a website, and other outreach to solicit reports about care quality; playing on its acronym, PDQ-MI aims to rapidly warn OC practices of brewing quality problems. PDQ-MI will be run through Disability Policy Consortium, a statewide disability civil rights advocacy group. The project will judge success by a PDQ-S survey after PDQ-MI is finished and interviews with OC clinicians, managers, and leaders and with Medicare and MassHealth officials. Three individuals with disabilities will co-lead this three-year project.
MeSH Terms:
  • Adult
  • Delivery of Health Care, Integrated /*organization & administration
  • * Disabled Persons
  • Dual MEDICAID MEDICARE Eligibility
  • Focus Groups
  • Humans
  • Language
  • Massachusetts
  • Medicaid
  • Medicare
  • Mental Disorders /rehabilitation
  • Middle Aged
  • Patient Participation
  • * Quality Indicators, Health Care
  • Quality of Health Care
  • Random Allocation
  • United States
  • Young Adult
Country: United States
State: Massachusetts
Zip Code: 02114
UI: 20143565
CTgovId: NCT02390557
Project Status: Completed
Record History: ('2018: Project extended to 2018.',)