Causes and Consequences of Health Care Efficiency

描述（由申请人提供）：我们最初的P01资助申请是由美国医疗保健强度的显着差异所激发的。在这次重新提交中，我们从三个方面突出我们的重点。目标是了解和提高效率，目标是医生和他们工作的医院更可操作的水平，方法包括与关键利益相关者合作设计成功的干预措施。这些项目是：1.衡量医疗服务提供者的效率。这个项目开发的效率措施-质量和成本-并探讨其在初级保健医生，医生团体和医院的水平的影响。我们使用医疗保险数据，患者和医生调查，以及来自美国内科医学委员会和美国家庭实践委员会的专业委员会认证分数。2.药物治疗效率变化的原因和后果。我们描述和模型的变化，在处方药的使用从非常大的保险提供商在两个州的纵向索赔数据，研究处方药使用的结果和一个大的，系统性的“冲击”的影响的变化的后果-医疗保险D部分-现有的治疗模式和结果。3.技术增长与卫生保健扩散效率。我们研究“高科技”医疗保健对成本增长的贡献、不同类型医疗创新的扩散、高质量的医疗服务提供者是否影响人口水平的健康结果，以及提供者网络如何影响扩散。4.地理和卫生保健的差异。我们提出了医院层面的差异“报告卡”，以研究不成比例的黑人医院的病人的分类，并测试是否从最近的全国范围内的医疗保险参保人的调查反映在他们的治疗患者的偏好。最后，我们估计手术率的种族差异如何影响实际健康结果的差异。5.规范管理医师决策为危重III老年人。我们使用定性的方法来描述的规范和价值观，影响使用的生命维持治疗重症老年人在急诊室和医院。我们计划测试一个或多个干预措施的可行性，以改变实践规范，更广泛的目标是提高效率。核心：核心包括一项与七家领先医院合作的倡议，以解决为健康和退休研究的用户提供护理，数据支持和健康效率措施方面的效率低下问题。相关性：该项目旨在了解为什么美国医疗保健系统的效率如此低下：30%的医疗保健支出被浪费，医疗质量严重缺乏。我们还探讨了几种方法来提高质量和减少不必要的变化支出。

DESCRIPTION (provided by applicant): Our original P01 grant application was motivated by the remarkable differences in health care intensity in the US. In this resubmission, we sharpen our focus in three ways. The goal is to understand and improve efficiency, the target is a more actionable level for physicians and the hospitals where they work, and the means include collaborations with key stakeholders to design successful interventions. The projects are: 1. Measuring the Efficiency of Health Care Providers. This project develops measures of efficiency - both quality and costs - and explores their implications at the level of primary care physicians, physician groups, and hospitals. We use Medicare data, patient and physician surveys, and specialty board certification scores from the American Board of Internal Medicine and the American Board of Family Practice. 2. Causes and Consequences of Variation in Pharmacotherapy Efficiency. We describe and model variation in prescription drug use using longitudinal claims data from very large insurance providers in two states, studying both consequences of variation in prescription drug use in outcomes and the impact of a large, systemic 'shock' - Medicare Part D - on existing treatment patterns and outcomes. 3. Technological Growth and the Efficiency of Health Care Diffusion. We study the contribution of "high- tech" health care to cost growth, the diffusion of different types of medical innovations, whether high-quality health providers affect population-level health outcomes, and how provider networks affect diffusion. 4. Geography and Disparities in Health and Health Care. We propose hospital-level disparity "report cards," to study sorting of patients to disproportionately Black hospitals and to test whether the preferences of patients from a recent nation-wide survey of Medicare enrollees are reflected in their treatments. Finally, we estimate how racial differences in surgical rates affect disparities in actual health outcomes. 5. Norms Governing Physician Decision-Making For Critically III Elders. We use qualitative methods to describe the norms and values that influence the use of life-sustaining treatments among critically ill elders in emergency rooms and hospitals. We plan to test the feasibility of one or more interventions to change practice norms with the broader aim of improving efficiency. Cores: The Cores include an initiative to work with seven leading hospitals to address inefficiency in the provision of care, data support, and health efficiency measures for users of the Health and Retirement Study. Relevance: The project seeks to understand why efficiency is so poor in the U.S. health care system: 30% of health care spending is wasted, and quality of care is seriously lacking. We also explore several approaches to improving quality and reducing unwarranted variations in expenditures.