Peer Effects in the Emergency Department on Productivity and Patient Choice

描述(由申请者提供)：医生可以通过同龄人的存在在社会上受到激励的概念是直观的。然而，医生之间的这些“同伴效应”的性质以前还没有被研究过。这个项目的目标是研究社会网络对医生个人行为和卫生保健组织整体生产力的影响。具体地说，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，我们将衡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。我们预测在更可观察的维度(例如，护理速度)和较不可观察的维度(例如，护理质量)之间进行权衡，我们预计，在社会联系更紧密的同龄人中，同伴效应将更强。其次，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病人(即“樱桃挑”)，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，我们将研究在不允许医生选择自己的病人的新制度下，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，他们通常对某些类型的患者有强烈的报告偏好，他们可能与同行分享，也可能与同行不同。有鉴于此，我们将使用研究设计的两个互补功能来实现我们的特定目标。首先，我们有关于个别医生和他们看过的病人的详细的纵向数据，包括相互合作的医生团队的充分差异。其次，正在研究的急诊科将于2011年5月进行一项自然实验，在该实验中，病人分配规则将不允许医生选择自己的病人。这项研究将阐明卫生保健组织应该如何设计团队结构中隐含的社交网络，以及管理团队内行为的规则。具体影响包括组织应该如何让同行相互匹配，他们应该以牺牲不太透明的措施为代价，在同事之间进行生产率衡量的透明度，以及他们应该在多大程度上隐含地约束社会行为，比如在医生之间选择病人。 与公共健康相关：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“同龄人”在场的影响。这项研究项目研究了这种“同伴效应”对生产力和病人选择的影响。除了研究医生在不同同事之间工作时的行为，这个项目还将在一个自然实验中研究对同伴效应的整体影响，在这个实验中，相同的急诊医生不再被允许选择自己的病人。

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.