Moral Hazard in Less Invasive Surgical Technology for Coronary Artery Disease

描述(由申请人提供)：该项目的具体目标是调查接受外科干预治疗的冠心病(CAD)患者术后行为变化的具体治疗差异，以及这些行为变化对患者健康结果和治疗成本的影响。经皮冠状动脉介入治疗(PCI)--一种新的、侵入性较小的手术--和冠状动脉搭桥术(CABG)是冠心病考虑的外科干预措施。争论中的行为变化与吸烟、没有定期锻炼、卡路里摄入量[部分反映在身体质量指数(BMI)和超重/肥胖]以及过度饮酒有关。冠状动脉介入治疗和冠脉搭桥术患者在这些行为改变上的差异是否可以解释表明前者的长期生存结果并不比后者更好？这些患者的行为对健康结果，特别是术后医疗支出、是否需要再干预以及死亡率结果是否有可衡量的影响？如果是这样的话，一旦行为改变保持不变，冠状动脉旁路移植术和经皮冠状动脉介入术患者的结局有何不同？假设手术后的行为变化是不同的，那些通过相对较小的侵入性手术(PCI)治疗的CAD患者在改善健康方面的投资(通过改善行为)的比率低于那些通过更具侵入性的CABG手术治疗的患者。这一假设植根于两种不同的手术干预向接受治疗的患者传达了关于冠心病严重性的不同信息。由于更严重的生理和心理提醒，与接受更具侵入性手术(CABG)的患者相比，接受较小侵入性技术(PCI)治疗的患者平均将更少的精力重新分配到医疗投资上。该项目将采用健康和退休调查/资产和高龄老年人健康动态调查、国家长期护理调查和国家健康访谈调查的数据。每项调查都将与联邦医疗保险索赔文件和国家死亡指数联系起来。多元分析将基于差异法和倾向分数匹配法。 与公共健康相关：如果经皮冠状动脉介入治疗患者抵消行为(在健康方面的投资较少)的假设被证明是正确的，那么有相对便宜和容易的方法来实施补充技术：有针对性的医生咨询、特定行为的患者随访和行为矫正计划。反过来，接受经皮冠状动脉介入治疗的患者健康状况的改善可能会导致：更高的存活率，减少或推迟需要再次干预的需要，以及医疗保健支出的减少。总体而言，所有这些发展都将进一步实现在冠心病治疗中引入侵入性较小的外科技术所带来的潜在福利改善。

DESCRIPTION (provided by applicant): The specific aims of this project are to investigate the treatment-specific differences in changes in post-operative behavior of patients who have been treated for coronary artery disease (CAD) with surgical intervention and the effects of these differences in behavior change on patient health outcomes and cost of treatment. Percutaneous coronary intervention (PCI)--the newer and less invasive procedure-- and coronary artery bypass graft (CABG) surgery are the surgical interventions for CAD considered. The behavioral changes at issue pertain to cigarette smoking, the absence of a regular exercise regimen, caloric intakes [reflected in part by body mass index (BMI) and overweight/obese], and excessive alcohol consumption. Can differences in these behavior changes between PCI and CABG patients account for evidence suggesting that long-term survival outcomes are no better for the former than for the latter? Is there a measurable impact on health outcomes, particularly post-operative medical expenditures, the need for reintervention, and mortality outcomes, related to these patient behaviors? If so, how do outcomes differ between CABG and PCI patients once changes in behavior are held constant? The hypothesis is that there are differences in post-operative behavior changes, and that those treated for CAD via the relatively less invasive surgery, PCI, will invest in health improvement (through improved behavior) at lower rates than those treated via the more invasive CABG surgery. This hypothesis is rooted in the idea that the two different surgical interventions convey different information about the seriousness of having CAD to the patient being treated. Due to more serious physical and psychological reminders, those treated with the less invasive technology (PCI) will on average reallocate less effort to health investments than those treated with the more invasive surgery (CABG). The project will employ data from the Health and Retirement Survey/Assets and Health Dynamics Among the Oldest Old, the National Long-Term Care Survey, and the National Health Interview Survey. Each survey will be linked to Medicare claims files and to the National Death Index. The multivariate analysis will be based on difference-in-differences and propensity score matching methods. PUBLIC HEALTH RELEVANCE: If the hypothesis of offsetting behavior (less investment in health) by PCI patients turns out to be correct, there are relatively inexpensive and easy ways to implement complementary technologies: targeted physician counseling, behavior-specific patient follow-up, and behavior modification programs. In turn, improved patient health outcomes for those treated with PCI could result: higher survival rates, a decreased need or delayed need for reintervention, and decreases in medical care spending. Overall all these developments would lead to further realization of the potential welfare improvement associated with the introduction of less invasive surgical technology in the treatment of CAD.