MARKET BASED REFORMS AND QUALITY OF CARE

描述：该项目将有两个子项目。首先，他们 审查市场力量-管理的医疗渗透-在 适当使用血管造影和药物治疗的医疗保险患者 阿美。他们还将检查管理型医疗的渗透率和死亡率，以及 再梗死。该项目将使用来自合作心血管公司的数据 项目，贝克？S市场名称，兰德的改进版 适当的工具，并与药物治疗指南一致。 他们将采用两步分层模型，第一步是病人 一是市场水平，二是市场水平。通过使用更广泛的一组 协变量，他们将有比其他研究更好的病例组合调整 有。 在第二个项目中，他们将考察护理的质量和结果 随着竞争的改变，休克、急性胃肠道出血、肺血栓和急性心肌梗死 新泽西州在1992年新泽西州的利率设定方法之后。纽约 将充当控件状态。将使用HCUP数据。他们将检查 急性心肌梗死患者的心导管和心脏血管重建术， 胃肠道出血的内窥镜检查，血栓患者的肺血管造影术。在……里面 每一个案例的研究对象都是概率或可能性，而不是它的 适当性。结果将包括死亡率。 这四种情况的好处是，它们都是专门治疗的 在住院的环境下--如果病人能坚持那么远的话。因此，应该有 不会因为较低的住院可能性或 在更严格的医疗保健计划下，将护理切换到门诊设置。 第二个项目基本上是前后比较，与 同期对照组捕捉长期趋势。

Description: This project will have two sub-projects. In the first, they will the examine role of market forces - managed care penetration - in the appropriate use of angiography and drug treatment for Medicare patients with AMI. They will also examine managed care penetration and mortality and reinfarction. This project will use data from Cooperative Cardiovascular Project, Baker?s market designations, a modified version of the RAND appropriateness instrument, and concordance with a guideline for drug therapy. They will employ a two step hierarchical model, with the first being a patient level and the second a market level. By using a more extensive set of covariates, they will have better case-mix adjustment than other studies have had. In the second project, they will look at quality and outcomes of care for shock, acute GI bleed, pulmonary embolus, and AMI as competition changed in New Jersey following the 1992 of New Jersey's rate setting approach. New York will act as a control state. HCUP data will be used. They will examine cardiac catheterization and cardiac revascularization for patients with AMI, endoscopy for GI bleeds, pulmonary angiograms for patients with embolisms. In each case the object of study is the rate or likelihood, not its appropriateness. Outcomes will include mortality. The advantages of these four conditions is that they are exclusively treated in an inpatient setting - if the patient makes it that far. Thus, there should be no selection issues caused by lower likelihood of hospitalization or switching care to outpatient settings under more stringent health care plans. The second project is basically a before and after comparisons with a contemporaneous control group to capture secular trends.