Physician Level Analysis of Medical Technology Diffusion: Coronary Stents Study

摘要/摘要 我的经济学博士学位训练的重点是实证产业组织，这个领域研究 企业、消费者和经济中其他主体之间的战略互动。自从获得博士学位以来，我 我开始探索一个新的领域，健康经济学，首先是通过我在兰德公司的工作，然后是在我的 明尼苏达大学助理教授。我探索了健康方面的各种话题 经济学从头开始在一个对我来说全新的领域建立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几个重要的研究议程 我最感兴趣的主题，并将我的研究知识扩展到我迄今为止所研究的范围之外。的 我想关注的关键主题是医疗创新和传播、激励对患者的作用 和提供者水平以及保险的作用。拟议的研究将使我能够：（1）发展以下方面的专业知识 医疗保险数据库分析； (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见解； （5）提高我开发研究项目的能力， 并撰写具有竞争力的 R01 级别资助资助； (6) 扩大我接触健康服务的范围 研究和卫生经济学界； 通过拟议的项目，我将开始制定一个长期研究议程，重点关注理解 采用和传播新医疗技术的机制。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力量对于解决问题至关重要 医疗技术的利用。然而，医生对医疗技术的采用尚未得到充分研究或 明白了。我的目标是调查竞争、社交网络和向其他医生学习如何 除了更传统的解释（例如， 根据医生、医院和患者的特点。 我建议研究使用冠状动脉支架的医疗技术在医疗保险中的传播 以人口为榜样。将医疗保险索赔与美国医生人口统计数据联系起来 医学协会和美国医院调查中的医院特征：(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情况随时间、地区和医院的不同而存在差异。 (2)我将估计医生特征、医生之间的竞争、社会互动的作用 （包括向其他医生学习），以及医生决定的预期患者人口统计数据 采用和使用新的支架。 (3) 我会估计医生使用新支架对患者的影响 支架置入后的结果，例如再入院率、重复经皮冠状动脉介入治疗 （PCI）和死亡率。

Summary/Abstract 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.