Evaluation of the Comprehensive Primary Care Plus (CPC+) Model
調査の概要
詳細な説明
This project is a large, seven-year mixed-methods evaluation of the Comprehensive Primary Care Plus (CPC+) Model, sponsored by the Centers for Medicare & Medicaid Services (CMS). CPC+ aims to improve the delivery of primary care; patients' cost, service use, and quality of care; and the experiences of patients, practitioners, and staff. It aims to achieve these goals by helping practices transform across five key care delivery functions: (1) access and continuity, (2) care management, (3) comprehensiveness and coordination, (4) patient and caregiver engagement, and (5) planned care and population health.
The national model includes two rounds, each of which will last for five years. Round 1 will take place from January 2017 through December 2021 and Round 2 from January 2018 through December 2022. A total of 2,877 primary care practices are participating in Round 1. The number of Round 2 practices will not be confirmed until September 2017.
From practices that applied to participate, CMS selected those that provide primary care, met specific certified health information technology (health IT) requirements, and were already engaging in certain care delivery activities. The CPC+ model includes two transformation tracks with incrementally advanced care delivery requirements and payment options. Participating practices will receive financial payments from CMS, including a monthly care management fee and prospective performance-based incentive payment, on top of traditional payments. Some practices will also receive some payment that shifts away from fee-for-service. In addition, practices will receive payments from other participating payers, representing a large proportion of their total revenue. CPC+ practices will receive learning support, data feedback, and health IT support to promote transformation.
To estimate the effect of CPC+, the investigators will compare the outcomes over time for CPC+ practices with the outcomes over time for a group of comparison practices. The investigators selected the comparison practices by identifying practices that matched the CPC+ practices on key characteristics. The investigators expect to include up to 8,397 comparison practices in Round 1.
The investigators will estimate the impact of CPC+ on patient outcomes by tracking the patients who are attributed to a study practice based on receiving most of their evaluation and management care from that practice. The investigators expect to include approximately 5,326,531 attributed patients across the CPC+ and comparison practices in Round 1 (the number of attributed patients for the Round 2 practices is to be determined). Analyses of Medicare (and in some regions Medicaid) claims data for patients attributed to the CPC+ and comparison practices will be conducted to estimate impacts on Medicare expenditures, our primary outcome, and service use and quality of care.
The investigators will also estimate the impact of CPC+ on practice care delivery approaches, and patient, practitioner, and staff experience. The investigators will administer a practice survey to the practice managers of all the study practices to track changes in care delivery and practice characteristics. The investigators will measure patient experience through a survey administered to Medicare fee-for-service beneficiaries attributed to the study practices. Changes in work environment and practitioner and staff experience with CPC+ will be measured through a survey of primary care practitioners of the study practices and staff of the CPC+ practices. For the Round 1 practices, the investigators expect to administer 11,244 practice surveys, 20,000 patient surveys, 10,996 practitioner surveys, and 10,429 staff surveys, The sample sizes for surveys for the Round 2 practices are to be determined. Telephone interviews and site visits will be conducted with CPC+ payers; practitioners and staff in the practices, and, if relevant, the systems and medical groups that own them; patients; and other stakeholders to understand what was implemented, and barriers and facilitators to implementation and improved outcomes.
研究の種類
入学 (予想される)
段階
- 適用できない
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- All Medicare fee-for-service patients who receive the largest share of their evaluation and management visits from one of the study primary care practices.
- Practice managers, practitioners, and staff of the study primary care practices.
Exclusion Criteria: None
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研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ヘルスサービス研究
- 割り当て：非ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的：CPC+ practices
This is the intervention group, and includes the practices that were selected and agreed to participate in the CPC+ model.
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CPC+ practices receive a monthly care management fee and prospective performance-based incentive payment on top of traditional payments.
Some practices will also receive some payment that shifts away from fee-for-service.
In addition, CPC+ practices will receive learning and health IT support and data feedback to implement processes to meet care delivery requirements and achieve five primary care functions.
|
|
介入なし：Comparison practices
Comparison practices are the control group.
This group includes practices not participating in the model that were matched to the CPC+ practices and whose outcomes will be compared to those of the CPC+ practices.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Total Part A and Part B claims paid by Medicare in 2017
時間枠：12 months
|
Total claims paid by Medicare for for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
12 months
|
|
Total Part A and Part B claims paid by Medicare in 2018
時間枠：24 months
|
Total claims paid by Medicare for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
24 months
|
|
Total Part A and Part B claims paid by Medicare in 2019
時間枠：36 months
|
Total claims paid by Medicare for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
36 months
|
|
Total Part A and Part B claims paid by Medicare in 2020
時間枠：48 months
|
Total claims paid by Medicare for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
48 months
|
|
Total Part A and Part B claims paid by Medicare in 2021
時間枠：60 months
|
Total claims paid by Medicare for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
60 months
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Claims paid by Medicare in 2017 by type of service and service utilization
時間枠：12 months
|
Claims paid by Medicare for each of following: physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
12 months
|
|
Claims paid by Medicare in 2018 by type of service and service utilization
時間枠：24 months
|
Claims paid by Medicare for each of following: physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
24 months
|
|
Claims paid by Medicare in 2019 by type of service and service utilization
時間枠：36 months
|
Claims paid by Medicare for each of following: physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
36 months
|
|
Claims paid by Medicare in 2020 by type of service and service utilization
時間枠：48 months
|
Claims paid by Medicare for each of following: physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
48 months
|
|
Claims paid by Medicare in 2021 by type of service and service utilization
時間枠：60 months
|
Claims paid by Medicare for each of following: physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
60 months
|
|
Claims paid by Medicaid in 2017
時間枠：12 months
|
Claims paid by Medicaid for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
12 months
|
|
Claims paid by Medicaid in 2018
時間枠：24 months
|
Claims paid by Medicaid for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
24 months
|
|
Claims paid by Medicaid in 2019
時間枠：36 months
|
Claims paid by Medicaid for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
36 months
|
|
Claims paid by Medicaid in 2020
時間枠：48 months
|
Claims paid by Medicaid for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
48 months
|
|
Claims paid by Medicaid in 2021
時間枠：60 months
|
Claims paid by Medicaid for physician services (primary care physician services, specialist services, and services provided by noninstitutional providers), inpatient hospital services, outpatient services, skilled nursing facility, durable medical equipment, hospice, and home health
|
60 months
|
|
Quality-of-care process measures for 2017 based on claims data
時間枠：12 months
|
Quality-of-care outcome measures based on claims data (including 30-day hospital readmissions, rate of hospitalizations for ambulatory care sensitive admissions, and likelihood of emergency department revisits)
|
12 months
|
|
Quality-of-care process measures for 2018 based on claims data
時間枠：24 months
|
Quality-of-care outcome measures based on claims data (including 30-day hospital readmissions, rate of hospitalizations for ambulatory care sensitive admissions, and likelihood of emergency department revisits)
|
24 months
|
|
Quality-of-care process measures for 2019 based on claims data
時間枠：36 months
|
Quality-of-care outcome measures based on claims data (including 30-day hospital readmissions, rate of hospitalizations for ambulatory care sensitive admissions, and likelihood of emergency department revisits)
|
36 months
|
|
Quality-of-care process measures for 2020 based on claims data
時間枠：48 months
|
Quality-of-care outcome measures based on claims data (including 30-day hospital readmissions, rate of hospitalizations for ambulatory care sensitive admissions, and likelihood of emergency department revisits)
|
48 months
|
|
Quality-of-care process measures for 2021 based on claims data
時間枠：60 months
|
Quality-of-care outcome measures based on claims data (including 30-day hospital readmissions, rate of hospitalizations for ambulatory care sensitive admissions, and likelihood of emergency department revisits)
|
60 months
|
|
Patient experience
時間枠：24 months
|
Self-reported measures of patient experience with primary care practitioner and practice
|
24 months
|
|
Patient experience
時間枠：36 months
|
Self-reported measures of patient experience with primary care practitioner and practice
|
36 months
|
|
Patient experience
時間枠：60 months
|
Self-reported measures of patient experience with primary care practitioner and practice
|
60 months
|
|
Practitioner and staff experience
時間枠：24 months
|
Self-reported measures of approaches to delivery of primary care and work experience at practice
|
24 months
|
|
Practitioner and staff experience
時間枠：48 months
|
Self-reported measures of approaches to delivery of primary care and work experience at practice
|
48 months
|
|
Practice's care delivery
時間枠：12 months
|
Self-reported measures of practice approaches to delivery of primary care
|
12 months
|
|
Practice's care delivery
時間枠：24 months
|
Self-reported measures of practice approaches to delivery of primary care
|
24 months
|
|
Practice's care delivery
時間枠：36 months
|
Self-reported measures of practice approaches to delivery of primary care
|
36 months
|
|
Practice's care delivery
時間枠：48 months
|
Self-reported measures of practice approaches to delivery of primary care
|
48 months
|
|
Practice's care delivery
時間枠：60 months
|
Self-reported measures of practice approaches to delivery of primary care
|
60 months
|
協力者と研究者
捜査官
- スタディディレクター：Deborah Peikes, Ph.D.、Mathematica Policy Research
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- CPCPlus2017
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
すべての条件の臨床試験
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Syracuse UniversityBill and Melinda Gates Foundation; Texas A&M University; Jimma University完了
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Group for Research in Adult Acute Lymphoblastic...募集
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PersonGen BioTherapeutics (Suzhou) Co., Ltd.まだ募集していません
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Institut National de la Santé Et de la Recherche...完了
CPC+ modelの臨床試験
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Boston Children's HospitalEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Beth... と他の協力者募集
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Virginia Commonwealth UniversitySigma Theta Tau International Honor Society of Nursing; Southern Nursing Research Society完了
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Boston Children's HospitalThe Hospital for Sick Children; Yale University; CURE Children's Hospital, Uganda積極的、募集していない
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Chase Pharmaceuticals Corporation, an affiliate...完了
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Chase Pharmaceuticals Corporation, an affiliate...完了
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University of PennsylvaniaMarch of Dimes積極的、募集していない
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Cumhuriyet University募集