Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending

作者：Laura Blue, Keith Kranker, Amanda Rose Markovitz, Rhea E. Powell, Malcolm Williams, Jia Pu, David J. Magid, Nancy T. McCall, Allison L. Steiner, Kate Stewart, Julia M. Rollison, Patricia Markovich, Greg Peterson · 发表于：JAMA · 年份：2023 · DOI：10.1001/jama.2023.19597 · 被引用次数：35 · 研究领域：Acute Myocardial Infarction Research、Health Promotion and Cardiovascular Prevention、Cardiovascular Health and Risk Factors

Importance: The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. Objective: To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. Design, Setting, and Participants: This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Intervention: Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Main Outcomes and Measures: Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) ide...