Moral Hazard in Less Invasive Surgical Technology for Coronary Artery Disease

描述（由申请人提供）：该项目的具体目的是调查接受手术治疗的冠心病（CAD）患者术后行为变化的治疗特异性差异，以及这些行为变化差异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）是一种较新的微创手术，冠状动脉旁路移植术（CABG）是CAD的外科干预措施。问题中的行为改变与吸烟、缺乏规律的锻炼、热量摄入（部分反映在身体质量指数（BMI）和超重/肥胖上）和过度饮酒有关。这些行为改变在PCI和CABG患者之间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的证据？这些患者行为是否对健康结果，特别是术后医疗支出、再干预需求和死亡率结果有可衡量的影响？如果是这样，在行为改变保持不变的情况下，CABG和PCI患者的结果有何不同？假设是术后行为改变存在差异，并且那些通过侵入性相对较小的手术（PCI）治疗CAD的患者比那些通过侵入性更强的CABG手术治疗的患者在健康改善（通过改善行为）方面的投资率更低。这一假设根植于这样一种观点，即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，接受微创技术（PCI）治疗的患者平均将更少的精力重新分配到健康投资上，而接受微创手术（CABG）治疗的患者则较少。该项目将采用来自健康和退休调查/老年人资产和健康动态、全国长期护理调查和全国健康访谈调查的数据。每项调查都将与医疗保险索赔档案和国家死亡指数相关联。多变量分析将基于差异中的差异和倾向评分匹配方法。

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.