Physician Level Analysis of Medical Technology Diffusion: A Study of Coronary Ste

描述（由申请人提供）：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、消费者和经济中其他主体之间战略互动的领域。自获得博士学位以来，我开始探索一个新的领域——卫生经济学，首先是通过在兰德公司的工作，然后是在明尼苏达大学担任助理教授。我探索了卫生经济学的各种主题，从零开始在一个对我来说全新的领域建立了一系列专业知识和实践知识。我职业发展的下一步自然是围绕我最感兴趣的几个重要主题进行研究议程，并扩展我的研究知识，超越我目前所学的知识。我想集中讨论的关键主题是医疗创新和推广，在患者和提供者层面激励的作用，以及保险的作用。提出的研究将使我能够：(1)发展医疗保险数据库分析的专业知识；(2)培养处理大型数据库的能力；(3)加强统计训练；(4)了解疾病，获得临床见解；(5)提高自己开展研究项目的能力，并在R01水平上撰写具有竞争力的资助；(6)扩大对卫生服务研究和卫生经济学社区的接触；通过拟议的项目，我将开始建立一个长期的研究议程，重点是了解新医疗技术采用和传播的机制。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因素，这表明了解影响医生技术采用和使用的力量对于解决医疗技术的利用问题至关重要。然而，医生对医疗技术的采用并没有得到很好的研究或了解。我的目标是调查竞争、社会网络和向其他医生学习如何影响医生医疗技术采用的模式，除了更传统的解释，如医生、医院和病人的特点。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人口为例。将医疗保险索赔与来自美国医学协会的医师人口统计数据以及来自美国医院调查的医院特征联系起来：(1)我将记录医生使用裸金属、涂层和药物洗脱支架的时间、地区和医院的变化。(2)我将评估医生的特点、医生之间的竞争、社会互动（包括向其他医生学习）和预期的患者人口统计对医生决定采用和使用新支架的作用。(3)我将评估医生使用新支架对患者置入支架后预后的影响，如再次入院率、重复经皮冠状动脉介入治疗（PCI）和死亡率。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Over the last 50 years, innovation in medical technology has been a key driver in both the improvement in life expectancy and the increase in health care costs. However, a large body of research suggests that medical technology innovations have not been evenly distributed throughout the population documenting significant variation in the timing, intensity and appropriateness of the use of medical care across regions, hospitals, physicians and patients. This variation suggests that new medical technologies are potentially under and over-utilized, and that medical care technology may not be optimally diffusing. The proposed career grant will build a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies by investigating the roles of competition, social networks and other more traditional explanations such as physician, hospital and patient characteristics on physician technology adoption.