5 - The Role of Information Technology & Treatment Heterogeneity in Population Health

项目摘要/摘要 项目5--信息技术和治疗异质性在人口健康中的作用 这项建议旨在更好地理解医生使用信息的潜在微观经济驱动因素 技术(IT)，重点是提供预防保健及其对下游人口健康的影响。 为此，我们将利用有关医生使用IT的独特、丰富的数据(逐秒)进行评估 患者是否有资格获得预防性护理，与传统数据来源(如索赔)和准随机变量相联系 在激励方面。 我们将结合机器学习和计量经济学的方法来i)轻松地描述IT的使用 基于众多潜在的使用模式，以及ii)了解IT使用数据的影响的异质性- 采用驱动方法进行评估。我们将能够研究信息技术对提供服务的平均影响 预防性护理。此外，我们将使用自然变异，其中激励措施从 预防保健过程.HbA1c水平筛查.中等健康结局.HbA1c水平 在控制之下。这将使我们能够评估IT对医生和患者在预防保健方面所做工作的影响，因为 以及对健康本身的影响。我们的方法不仅允许我们考虑IT的平均影响，还允许我们考虑 其对获得和坚持预防性保健的异质性影响的潜在来源。例如, 在糖尿病患者中，是否对患者进行适当预防性筛查是首要决定因素 去看医生，或在去看医生的条件下，医生是否提供适当的筛查？ 这些护理利润率如何取决于对IT的访问以及医生、患者和治疗的异质性？ 这些区别对设计改善健康的干预措施和激励措施具有重要意义。 在糖尿病人群中--以及更广泛的预防。它还有可能提供有针对性的 个人层面的信息和治疗指南。 以这种方式扩大信息技术的范围可以提高有针对性的医疗在 练习一下。然而，个人和他们的医生实际上是如何采用IT并使用它来应对即使是简单的 指导方针是评估如何最好地传播以患者为中心的信息和个性化的关键 治疗建议，主要目标是改善人口健康。我们将确定差异 除平均治疗外，由一系列不同的医疗治疗引起的健康结果 通常研究的影响。我们将使用我们的结果来评估信息技术驱动的潜在人口健康收益 个性化治疗建议，告知旨在最好地利用资源来改善 卫生保健管理和老龄化人口的健康。

PROJECT SUMMARY/ABSTRACT Project 5 – The Role of Information Technology & Treatment Heterogeneity in Population Health This proposal seeks to better understand the underlying microeconomic drivers of physician use of information technology (IT), with a focus on the provision of preventive care and its downstream population health impacts. To do so, we will leverage unique, rich data on physician use of IT (at the second-by-second level) to assess patient eligibility for preventive care, linked to traditional data sources (e.g. claims), and quasi-random variation in incentives. We will incorporate methods from machine learning and econometrics to i) tractably characterize use of IT based on numerous potential patterns of use and ii) understand heterogeneity in impacts of IT using data- driven approaches to estimation. We will be able to study the average impact of IT on the provision of preventive care. In addition, we will use natural variation in which incentives were moved from measures of the process of preventive care – screening for HbA1c level – to intermediate health outcomes – HbA1c levels under control. This will allow us to assess the impact of IT on physician and patient effort on preventive care as well as the impact on health itself. Our approach allows us to consider not only the mean impact of IT, but also the potential sources of its heterogeneous impacts on access and adherence to preventive care. For example, among diabetic patients, is the primary determinant of appropriate preventive screening whether the patient visits the doctor or, conditional on visiting the doctor, whether the physician provides appropriate screening? How do these margins for care depend on access to IT, and physician, patient, and treatment heterogeneity? These distinctions have important implications for designing interventions and incentives to improve health among the diabetic population – and prevention more broadly. IT also has the potential to provide targeted individual-level information and treatment guidelines. Enhancing the scope of IT in this way could improve the effectiveness of targeted medical treatments in practice. However, how individuals and their doctors actually adopt IT and use it to respond to even simple guidelines is critical in assessing how to best disseminate patient-centered information and personalized treatment recommendations, with the primary goal of improving population health. We will identify the variance of health outcomes induced by a range of different medical treatments, in addition to the mean treatment impacts typically studied. We will use our results to assess the potential population health gains from IT-driven personalized treatment recommendations, informing policies designed to best use resources to improve the health care management and health of an aging population.