Physician Level Analysis of Medical Technology Diffusion: Coronary Stents Study

医疗技术扩散的医师水平分析：冠状动脉支架研究

• 批准号: 8149850
• 负责人: PINAR KARACA-MANDIC
• 金额: $ 12.4万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149850
• 关键词: Address; Admission activity; Adopted; Adoption; Affect; American; American Medical Association; Caring; Characteristics; Clinical; Communities; Coronary; Coronary artery; Data; Databases; Development; Diffuse; Diffusion; Diffusion of Innovation; Disease; Doctor of Philosophy; Drug Approval; Economics; Employment; Exposure to; Funding; Goals; Grant; Health Care Costs; Health Services Research; Hospitals; Incentives; Industry; Inpatients; Insurance; Insurance Coverage; Knowledge; Learning; Life Expectancy; Link; Literature; Marketing; Medical; Medical Technology; Medicare; Medicare claim; Metals; Minnesota; Outcome; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Physician' s Role; Physicians; Play; Population; Positioning Attribute; Productivity; Provider; Research; Research Project Grants; Role; Services; Social Interaction; Social Network; Social Welfare; Socioeconomic Status; Stents; Surveys; Technology; Time; Training; Universities; Variant; Work; Writing; career; career development; cost effective; demographics; driving force; field study; geographic difference; health economics; improved; innovation; insight; interest; mortality; new technology; payment; percutaneous coronary intervention; population health; professor; public health relevance; social competition

DESCRIPTION (provided by applicant): The focus of my PhD training in economics was empirical industrial organization, a field that studies strategic interactions between firms, consumers and other agents in the economy. Since obtaining my PhD, I have started exploring a new field, health economics, first through my employment at RAND, then in my position as an assistant professor at the University of Minnesota. I have explored various topics in health economics to build from scratch a spectrum of expertise and hands-on knowledge in a field brand new for me. A natural next step for my career development is to focus on a research agenda around several important themes that interest me most, and to expand my research knowledge beyond what I have studied thus far. The key themes I would like to focus on are medical innovation and diffusion, the role of incentives at the patient and provider level, and the role of insurance. The proposed study will allow me to:(1) develop expertise in the analysis of Medicare database; (2) build capability in working with large databases; (3) enhance my statistical training; (4) understand diseases and gain clinical insights; (5) improve my ability to develop research projects, and to write grants competitive for funding at the R01 level; (6) expand my exposure to health services research and health economics community; Through the proposed project, I will start building a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies. In most circumstances, physicians are the key agent in determining whether a patient receives a given medical technology, suggesting that understanding the forces that affect physician technology adoption and use is critical to addressing utilization of medical technology. However, physician adoption of medical technology is not well studied or understood. My goal is to investigate how competition, social networks and learning from other physicians affect patterns of physician medical technology adoption in addition to the more traditional explanations such as physician, hospital and patient characteristics. I propose to study the diffusion of medical technology using coronary artery stents in the Medicare population as the exemplar. Linking Medicare claims to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Survey: (1) I will document the variation across time, regions, and hospitals in physicians' use of bare-metal, coated and drug eluting stents. (2) I will estimate the role of physician characteristics, competition among physicians, social interactions (including learning from other physicians), and expected patient demographics on the physician's decision to adopt and use new stents. (3) I will estimate the consequences of physicians' use of new stents on patients' outcomes following stent insertion, such as rates of re-admissions, repeat percutaneous coronary interventions (PCI), and mortality. PUBLIC HEALTH RELEVANCE: Over the last 50 years, innovation in medical technology has been a key driver in both the improvement in life expectancy and the increase in health care costs. However, a large body of research suggests that medical technology innovations have not been evenly distributed throughout the population documenting significant variation in the timing, intensity and appropriateness of the use of medical care across regions, hospitals, physicians and patients. This variation suggests that new medical technologies are potentially under and over-utilized, and that medical care technology may not be optimally diffusing. The proposed career grant will build a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies by investigating the roles of competition, social networks and other more traditional explanations such as physician, hospital and patient characteristics on physician technology adoption.

描述(由申请人提供)：我的经济学博士培训的重点是实证产业组织，这是一个研究企业、消费者和经济中其他代理人之间战略互动的领域。自从获得博士学位以来，我开始探索一个新的领域，卫生经济学，首先是通过我在兰德的工作，然后是我在明尼苏达大学的助理教授的职位。我探索了卫生经济学的各种主题，从头开始在一个对我来说全新的领域建立了一系列专业知识和实践知识。我职业发展的下一步自然是专注于围绕我最感兴趣的几个重要主题的研究议程，并扩大我的研究知识，使其超出我迄今所学的范围。我想要关注的关键主题是医疗创新和传播，患者和提供者层面的激励作用，以及保险的作用。拟议的研究将使我能够：(1)发展联邦医疗保险数据库分析方面的专业知识；(2)建立使用大型数据库的能力；(3)加强我的统计培训；(4)了解疾病并获得临床洞察力；(5)提高我开发研究项目的能力，并在R01级别编写具有竞争力的资金拨款；(6)扩大我对医疗服务研究和医疗经济学社区的接触；通过拟议的项目，我将开始建立一个长期研究议程，重点是了解新医疗技术采用和传播背后的机制。在大多数情况下，医生是决定患者是否接受特定医疗技术的关键因素，这表明了解影响医生技术采用和使用的因素对于解决医疗技术的利用至关重要。然而，医生对医疗技术的采用并没有得到很好的研究或理解。我的目标是调查竞争、社交网络和向其他医生学习如何影响医生医疗技术的采用模式，以及医生、医院和患者特征等更传统的解释。我建议以冠状动脉支架在医疗保险人群中的传播为样本来研究医疗技术的传播。将Medicare声称与美国医学会的医生人口统计数据和美国医院调查的医院特征联系起来：(1)我将记录医生使用裸金属支架、涂层支架和药物洗脱支架的时间、地区和医院之间的差异。(2)我将评估医生的特征、医生之间的竞争、社会互动(包括向其他医生学习)以及预期的患者人口统计对医生采用和使用新支架的决定的作用。(3)我将评估医生使用新支架对支架置入后患者预后的影响，如再入院率、重复经皮冠状动脉介入治疗(PCI)和死亡率。 公共卫生相关性：在过去的50年里，医疗技术的创新一直是延长预期寿命和增加医疗保健成本的关键驱动力。然而，大量研究表明，医疗技术创新在人口中的分布并不均匀，这表明各地区、医院、医生和患者在使用医疗保健的时间、强度和适当性方面存在显著差异。这一变化表明，新的医疗技术可能没有得到充分和过度的利用，医疗保健技术可能没有得到最佳的传播。拟议的职业拨款将建立一个长期研究议程，重点是通过调查竞争、社交网络和其他更传统的解释(如医生、医院和患者特征)对医生技术采用的作用，了解新医疗技术的采用和传播的潜在机制。