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：
8743315
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/8743315
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）：经过数十年的医疗保健支出增长，很少有人不同意必须重组美国的医疗保健，以便以较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，医生在很大程度上是通过订购成像，诊断测试，程序和医院服务来实现医疗保健利用率的增长。然而，关于医师实践模式的差异以及这些差异对患者的结果的影响还有很多尚待了解。从更广泛的角度来看，量化个人医生临床和经济结果差异的研究机构很少，并且对可能影响的各种个人医师和制度因素有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，旨在广泛理解决定医师实践模式的因素；个人实践变化对患者预后的影响；以及选定的机构和环境因素对医生临床和经济结果的影响。通过将一组独特的数据库联系在一起（医疗保险受益人的医疗主张；对这些患者关心的医生的人口统计和医学培训信息；以及这些医生的渎职要求），拟议的研究将全面研究医师支出，护理质量以及患者的质量以及“解剖学家”的差异和决定因素。除了量化医生之间临床和经济成果的差异外，拟议的研究还将为一组精心选择的医师活动组合评估：（1）如何支出，护理质量以及结果与医生年龄，性别，医学培训和实践环境相关，（2）与那些对临床的临床态度相比，对自己的临床态度更大，是否会造成更多的临床效果（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）（3）他/她随后的护理质量，支出和成果，（4）医疗培训环境的变化（例如，住院医师每周工作时间的强制性减少）如何影响医生的职业生涯，以及（5）医生实践模式如何应对其实践的当地经济环境。这项研究的最终目的是为卫生政策研究人员，医师和决策者提供基于医师改善护理质量并减少浪费的医疗保健支出的有形医师政策的科学基础。