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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）：经过几十年医疗保健支出的过度增长，很少有人会不同意美国医疗保健必须进行重组，以更低的成本实现相同或更好的患者结果。作为医疗保健领域的关键决策者，医生在很大程度上通过订购成像、诊断测试、程序和医院服务来促进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，还有很多有待了解的地方。更广泛地说，量化个体医生的临床和经济结果差异的研究很少，对可能影响这种差异的各种个体医生和机构因素的了解也较少