Peer Effects in the Emergency Department on Productivity and Patient Choice

描述（由申请人提供）：医生可以通过同行的存在而受到社会激励的概念是直观的。然而，这些“同行效应”的性质在医生之间以前没有被研究过。本研究的目的是研究社交网络对个体医生行为和医疗机构整体生产力的影响。具体来说，我们将评估急诊科医生在一起工作时对彼此的影响。具体目标有三个方面。首先，我们将测量同伴对个人生产力的影响--沿着护理速度、护理质量和教学的维度。我们预测更可观察的维度之间的权衡（例如，护理速度）和较不易观察的（例如，护理质量），我们预计同伴效应在社会关系更密切的同伴中会更强。第二，我们将研究同行对医生选择病人的影响。个别医生可能希望选择容易的患者（即，“樱桃采摘”），但社交网络可能会通过社会压力和适当的工作协调来缓解这一点。第三，我们将研究在一个不允许医生选择自己的病人的新系统下，对急诊科整体生产力的影响。初步结果表明，急诊医生的工作效率不同，他们经常对某些类型的患者有强烈的偏好，他们可能与同行分享或不同。鉴于此，我们将使用我们的研究设计的两个互补功能来实现我们的特定目标。首先，我们有详细的纵向数据，关于医生个人和他们所见的病人，包括医生团队之间的充分差异。第二，被研究的急诊科在2011年5月进行了一项自然实验，在这项实验中，病人分配规则将不允许医生选择自己的病人。这项研究将阐明医疗保健组织应该如何设计他们的社交网络隐含在团队结构和规则，管理团队内的行为。具体的影响包括组织应该如何匹配同行，他们应该如何透明，使同行之间的生产力措施，以牺牲不透明的措施，以及他们应该在多大程度上限制隐性社会行为，如医生之间的病人的选择。 公共卫生相关性：像任何其他类型的工作者一样，医生的行为可能会受到同事或“同行”的影响。“这项研究项目研究了这种“同伴效应”对病人的生产力和选择。除了研究医生在不同同事之间工作时的行为外，该项目还将研究在自然实验中对同行效应的总体影响，在该实验中，不再允许相同的急诊医生选择自己的病人。

DESCRIPTION (provided by applicant): The notion that physicians can be socially incentivized by the presence of their peers is intuitive. However, the nature of these "peer effects" among physicians has not previously been studied. The objective of this project is to study the effect of social networks on the behavior of individual physicians and on the overall productivity of health care organizations. Specifically, we will evaluate the effects of emergency department physicians on each other as they work together. Specific aims are threefold. First, we will measure peer effects on individual productivity - along dimensions of speed of care, quality of care, and teaching. We predict tradeoffs between more observable dimensions (e.g., speed of care) and less observable ones (e.g., quality of care), and we expect that peer effects will be stronger among more socially connected peers. Second, we will study peer effects on the choice of patients by physicians. Individual physicians may want to choose easy patients (i.e., "cherry pick"), but social networks may mitigate this by social pressure and appropriate coordination of work. Third, we will study the effect on overall emergency department productivity under a new system that disallows physicians from choosing their own patients. Preliminary results show that emergency physicians differ in their productivity and that they often have strong reported preferences for certain types of patients, which they may share with or differ from their peers. Given this, we will use two complementary features of our research design to accomplish our specific aims. First, we have detailed, longitudinal data on individual physicians and the patients that they see, involving sufficient variation in the teams of physicians working with each other. Second, the emergency department being studied is undertaking a natural experiment in May of 2011 in which the rules of patient assignment will disallow physicians from choosing their own patients. This research will shed light on how health care organizations should design their social networks implicit in team structures and the rules that govern behavior within teams. Specific implications include how organizations should match peers with each other, how transparent they should make productivity measures among peers at the expense of less transparent measures, and how much they should constrain implicitly social behaviors such as the choice of patients among physicians. PUBLIC HEALTH RELEVANCE: Like any other type of worker, physicians may be influenced in their behavior by the presence of their colleagues or "peers." This research project studies such "peer effects" on productivity and choice of patients. In addition to studying the behavior of physicians as they work among different colleagues, this project will study the overall impact on peer effects in a natural experiment in which the same emergency physicians are no longer allowed to choose their own patients.