Twelve communities will serve as focal points in an ambitious attempt to track changes in the nation's healthcare delivery system.The Washington-based Center for Studying Health System Chang e last week revealed the sites chosen for study and announced the selection of two contractors that will conduct research for the $8.8 million Community Tracking Study. The 12 sites were selected randomly from among more highly pop ulated and HMO-penetrated areas and stratified to generate a sample that would be representative of the nation's population, said health economist Paul B. Ginsburg, the center's president. Because of the difficulties involved in st udying large metropolitan areas, the sample excludes New York City and Los Angeles, for example, focusing instead on Syracuse, N.Y., and Orange County, Calif., he said.Another 48 sites around the country will be studied in lesser d etail, providing "a national portrait of health system change." These cities aren't being disclosed because the data won't be analyzed by site but, rather, "will permit statistically reliable conclusions to be drawn about health system changes in the nation," Ginsburg said.The former executive director of the Physician Payment Review Commission was tapped more than a year ago to lead the Center for Studying Health System Change, which is being funded at least for the next two years by the Robert Wood Johnson Foundation (Jan. 30, 1995, p. 22). The center is part of the Princeton, N.J.-based foundation's Health Tracking Initiative, a project to examine changes in the nation's health care system and how they are affecting people.The center, an affiliate of Princeton-based Mathematica Policy Research, became operational last spring and revealed results of a 15-site pilot study at a December 1995 conference. The so-called Community Snapshots Study helped to frame the upcoming Community Tracking Study and, according to Ginsburg, yielded some surprising findings, such as the pervasiveness of health system change even where "we expected them to be relatively sleepy." The first two-year round of the Community Tracking Study is designed to provide baseline data. It will enable researchers to assess change in those communities over time, analyze differences among commun ities and relate characteristics of the various health systems to health outcomes.Researchers will attempt to answer two broad questions: "How is the organization of the health system changing?" and "How do these changes affect people?"The Center has awarded $1.7 million to Lewin-VHI, a Fairfax, Va.-based consulting firm, to interview key constituencies, hold focus groups and conduct follow-up calls with select individuals in the 12 sites. A $1.6 million contract was given to the Gallup Organization, Princeton, to survey 12,600 randomly selected primary-care physicians and specialists in all 60 communities targeted for study, including the 12 sites identified for in-depth analysis .Mathematica, a research and consulting firm, will receive $5.5 million to interview 20,000 families in the 60 sites about their health insurance coverage, access to care, use of health services, health status and satisfaction with the care they receive.
THE WEEK IN HEALTHCARE;SYSTEMS;STUDY OF U.S. SYSTEM TO FOCUS ON 12 SITES
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