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Physician Level Analysis of Medical Technology Diffusion: Coronary Stents Study

医疗技术扩散的医师水平分析：冠状动脉支架研究

基本信息

批准号：
8721292
负责人：
PINAR KARACA-MANDIC
金额：
$ 12.39万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8721292
关键词：
Address Admission activity Adopted Adoption Affect American American Medical Association Caring Characteristics Clinical Communities Coronary Coronary artery Data Databases Development Diffuse Diffusion Diffusion of Innovation Disease Doctor of Philosophy Drug Approval Economics Employment Exposure to Funding Goals Grant Health Care Costs Health Services Research Hospitals Incentives Industry Inpatients Insurance Insurance Coverage Knowledge Learning Life Expectancy Link Literature Marketing Medical Medical Technology Medicare Medicare claim Metals Minnesota Outcome Outpatients Patients Pattern Pharmaceutical Preparations Physician&apos s Role Physicians Play Population Positioning Attribute Productivity Provider Research Research Project Grants Role Services Social Interaction Social Network Social Welfare Socioeconomic Status Stents Surveys Technology Time Training Universities Variant Work Writing abstracting career career development cost effective demographics driving force field study geographic difference health economics improved innovation insight interest mortality new technology payment percutaneous coronary intervention population health professor social competition

项目摘要

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.

总结/摘要我的经济学博士课程的重点是实证产业组织，这是一个研究企业、消费者和其他经济主体之间的战略互动。自从获得博士学位，我我开始探索一个新的领域，卫生经济学，首先是通过我在兰德的工作，然后在我的明尼苏达大学的助理教授。我探讨了健康方面的各种话题经济学从零开始建立一个专业知识和实践知识的范围在一个全新的领域对我来说。我职业发展的下一步自然是围绕几个重要的研究议程我希望能找到我最感兴趣的主题，并扩大我的研究知识，超越我迄今为止所研究的。的我想关注的关键主题是医疗创新和传播，激励措施在患者中的作用，和供应商层面，以及保险的作用。建议的研究将使我能够：（1）发展医疗保险数据库的分析;（2）建立与大型数据库合作的能力;（3）提高我的统计能力培训;（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，并在R 01水平上编写有竞争力的资助;（6）扩大我对卫生服务的接触研究和卫生经济学界; 通过拟议的项目，我将开始建立一个长期的研究议程，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代理人，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利用医疗技术。然而，医生对医疗技术的采用没有得到很好的研究，明白我的目标是调查竞争、社交网络和向其他医生学习影响医生医疗技术采用的模式，除了更传统的解释，医生、医院和病人的特征。我建议研究医疗技术的扩散使用冠状动脉支架在医疗保险以人口为榜样。将医疗保险索赔与美国医生的人口统计数据联系起来医学协会和美国医院调查的医院特征：（1）我将记录医生使用裸金属、涂层和药物洗脱支架的时间、地区和医院差异。 (2)我将评估医生特征的作用，医生之间的竞争，社会互动（包括从其他医生那里学习），以及医生决定采用和使用新支架。(3)我将评估医生使用新支架对患者的影响，支架植入后的结局，如再次入院率、重复经皮冠状动脉介入治疗率 (PCI)和死亡率。