Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks
Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks
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医生的执业方式和患者的健康结果：心脏病发作的案例
DOI：
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Jessica Van Parys
中科院分区：
文献类型：
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作者：
J. Currie;W. Macleod;Jessica Van Parys
当急性心肌梗死（AMI）患者到达急诊室时，值班提供者必须迅速决定如何积极治疗患者。使用1992-2014年所有此类患者的佛罗里达数据，我们将实践风格分解为两个组成部分：提供者对普通患者进行侵入性手术的概率（我们将其描述为侵略性），以及手术选择对患者特征的响应性。我们发现，在医院和几年内，更积极的提供者的患者始终具有更高的成本和更好的结果。由于所有患者都受益于侵入性手术的更高利用率，因此将手术用于最合适的患者会使这些患者受益，而不太合适的患者则会受益。我们还发现，最积极和反应最快的医生是年轻的男性，并在前20名的学校接受过培训。
When a patient arrives at the Emergency Room with acute myocardial infarction (AMI), the provider on duty must quickly decide how aggressively the patient should be treated. Using Florida data on all such patients from 1992-2014, we decompose practice style into two components: The provider’s probability of conducting invasive procedures on the average patient (which we characterize as aggressiveness), and the responsiveness of the choice of procedure to the patient’s characteristics. We show that within hospitals and years, patients with more aggressive providers have consistently higher costs and better outcomes. Since all patients benefit from higher utilization of invasive procedures, targeting procedure use to the most appropriate patients benefits these patients at the expense of the less appropriate patients. We also find that the most aggressive and responsive physicians are young, male, and trained in top 20 schools.