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Physician Determinants of Health Care Spending, Quality, and Patient Outcomes

医疗保健支出、质量和患者结果的医生决定因素

基本信息

批准号：
8609758
负责人：
Anupam Bapu Jena
金额：
$ 42.38万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-26 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8609758
关键词：
Affect Age Anatomy Area Behavior Behavioral Caring Case Mixes Characteristics Clinical Cognitive Complex Data Databases Decision Making Diagnostic tests Economic Factors Economics Environment Environmental Risk Factor Fee-for-Service Plans Financial compensation Goals Growth Health Policy Healthcare Hospitals Hour Image Individual Learning Left Link Literature Malpractice Measures Medical Medical Education Medical Residency Medicare claim Methods Metric Myocardial Infarction Natural experiment Outcome Outpatients Patient Care Patients Pattern Physician&apos s Practice Patterns Physicians Policies Procedures Quality of Care Race Randomized Recording of previous events Research Research Personnel Residencies Services Shock System Training Variant Work base beneficiary care episode career cost economic outcome environmental change experience geographic difference health care service utilization improved longitudinal database patient population payment public health relevance sex

项目摘要

DESCRIPTION (provided by applicant): After decades of excessive growth in health care spending, few would disagree that U.S. healthcare must be reorganized to achieve the same or better patient outcomes at lower cost. As the key decision makers in healthcare, physicians are in large part responsible for growth in healthcare utilization through ordering of imaging, diagnostic tests, procedures, and hospital services. And yet, much remains to be learned about variation in physician practice patterns and the implications of those differences for the outcomes of their patients. More broadly, the body of research quantifying the variation in clinical and economic outcomes across individual physicians is sparse and a greater understanding of the various individual physician and institutional factors that may influence that variation is needed. By combining economic methods with carefully chosen clinical scenarios, I will build a long-term research agenda that seeks to broadly understand factors determining physician practice patterns; the implications of individual practice variations for patient outcomes; and the impact of selected institutional and environmental factors on clinical and economic outcomes of physicians. By linking together a unique set of databases (medical claims of Medicare beneficiaries; demographic and medical training information of the physicians caring for these patients; and malpractice claims of these physicians), the proposed research will comprehensively study the variation and determinants of physician spending, quality of care, and patient outcomes, i.e. the 'anatomy' of physician behavior. In addition to quantifying variation in clinical and economic outcomes across physicians, the proposed research will, for a carefully chosen set of physician activities, assess: (1) how spending, qualit of care, and outcomes relate to physician age, sex, medical training, and practice environment, (2) whether clinical outcomes for physicians that spend more on average are better than those that spend less, (3) how a physician's own malpractice history affects his/her subsequent quality of care, spending, and outcomes, (4) how changes in medical training environments (e.g. mandated reductions in weekly work hours of resident physicians) impact physicians later in their career, and (5) how physician practice patterns respond to the local economic environments in which they practice. The ultimate goal of this research is to provide health policy researchers, physicians, and policymakers the scientific basis for tangible physician-based policies to improve quality of care and reduce wasteful health care spending.

描述（由申请人提供）：经过几十年的过度增长，在医疗保健支出，很少有人会不同意，美国医疗保健必须进行重组，以实现相同或更好的病人结果以更低的成本。作为医疗保健的关键决策者，医生通过订购成像，诊断测试，程序和医院服务，在很大程度上负责医疗保健利用率的增长。然而，关于医生实践模式的变化以及这些差异对患者结果的影响，还有很多东西有待了解。更广泛地说，量化个体医生临床和经济结果差异的研究很少，并且对可能影响这一结果的各种个体医生和机构因素有了更深入的了解。需要变化。通过将经济方法与精心选择的临床方案相结合，我将建立一个长期的研究议程，旨在广泛了解决定医生执业模式的因素;个人执业差异对患者结局的影响;以及选定的制度和环境因素对医生临床和经济结局的影响。通过将一组独特的数据库（医疗保险受益人的医疗索赔;照顾这些患者的医生的人口统计和医疗培训信息;以及这些医生的医疗事故索赔）连接在一起，拟议的研究将全面研究医生支出，护理质量和患者结局的变化和决定因素，即医生行为的“解剖学”。除了量化医生之间临床和经济结果的差异外，拟议的研究还将针对精心选择的一组医生活动评估：（1）支出、护理质量和结果如何与医生年龄、性别、医疗培训和执业环境相关，（2）平均支出较多的医生的临床结果是否优于支出较少的医生，（3）医生自己的医疗事故历史如何影响他/她随后的护理质量，支出和结果，（4）医疗培训环境的变化（例如住院医生每周工作时间的强制减少）如何影响医生以后的职业生涯，以及（5）医生的实践模式如何响应他们实践的当地经济环境。这项研究的最终目标是为卫生政策研究人员、医生和政策制定者提供科学依据，以制定切实的以医生为基础的政策，提高医疗质量，减少浪费性的医疗支出。