Quality of Care, Health Outcomes, and Costs among COPD Patients Following Improved Access to Health Care

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Project Summary/Abstract This career development award for Dr. Aaron Baum, an assistant professor of health system design and global health at the Icahn School of Medicine at Mount Sinai, will establish him as an investigator who researches health services and policies designed to improve access to quality health care for COPD patients. This K01 award will enable Dr. Baum to expand his research area and grow into an independent investigator by establishing his expertise in the following areas through formal coursework and strong mentoring: 1) Clinical epidemiology of COPD (etiology, patient impacts, and long-term outcomes) 2) health services research (measurement of access to and quality of care, and the VA's integrated delivery system, non-VA care for veterans, and the VA Choice Act) and 3) statistical learning (for heterogeneous treatment effects). Dr. Baum will pursue these training goals guided by a multidisciplinary faculty team led by primary mentor Dr. Juan Wisnivesky, a highly experienced junior faculty mentor with experience performing high-impact COPD comparative effectiveness research. An advisory committee composed of highly regarded principal investigators in health services research DQG statistical learning will provide additional guidance. COPD is a prevalent, undertreated and devastating chronic lung disease for which substantial geographic disparities in access to care exist across the United States. The supply of primary care providers and pulmonologists per COPD patient is low in many areas of country where the prevalence of COPD and rates of exacerbations are comparatively high. Whether increasing the supply of primary and pulmonary care providers available to individuals with COPD is likely to lead to increased use of primary or pulmonary care, improve quality of care, or reduce COPD exacerbations, readmission rates, or costs remains unclear. Dr. Baum will leverage the Veterans Choice Program, which increased the supply of covered primary care providers and pulmonologists available to eligible veterans, as a natural experiment to investigate three integrated aims: he will evaluate whether increasing the supply of covered primary and pulmonary care providers available to COPD patients is associated with increased utilization of primary and pulmonary care and improved quality of care (Aim 1), and with reduced COPD exacerbations, 30-day readmission rates, and annual costs of care (Aim 2); and he will identify subpopulations of COPD patients most likely to benefit from increasing access to providers (Aim 3). By leveraging quasi-random variation in eligibility and applying state-of-the-art econometric and statistical learning techniques to nationally integrated clinical and claims data, Dr. Baum expects to significantly advance understanding of the impacts of increasing the supply of primary and pulmonary care providers available to COPD patients. After accomplishing the training and research aims in this project, Dr. Baum will be well on his way to becoming an independent investigator who produces evidence on health services and policies that improve access to quality care and outcomes for COPD patients.