Causes and Consequences of Health Care Efficiency

描述(由申请人提供)：我们最初的P01拨款申请是出于美国医疗保健强度的显著差异。在这次重新提交中，我们从三个方面突出了我们的重点。目标是了解和提高效率，目标是医生及其工作的医院更具可操作性，手段包括与关键利益攸关方合作设计成功的干预措施。这些项目是：1.衡量卫生保健提供者的效率。这个项目开发了效率的衡量标准--包括质量和成本--并探讨了它们在初级保健医生、医生群体和医院层面的影响。我们使用医疗保险数据、患者和医生调查，以及来自美国内科医学委员会和美国家庭实践委员会的专业委员会认证分数。2.药物治疗效果变异的原因和后果。我们使用两个州非常大的保险提供商的纵向索赔数据来描述处方药使用的差异并对其进行建模，研究结果中处方药使用差异的后果，以及大型系统性“休克”--联邦医疗保险D部分--对现有治疗模式和结果的影响。3.技术增长和卫生保健传播的效率。我们研究了高科技医疗对成本增长的贡献，不同类型医疗创新的扩散，高质量的医疗服务提供者是否影响人口水平的健康结果，以及提供者网络如何影响扩散。4.卫生和保健方面的地理位置和差距。我们提出了医院级别的差异“成绩单”，以研究将患者分类到不成比例的黑人医院，并测试最近对医疗保险参与者进行的全国调查中患者的偏好是否反映在他们的治疗中。最后，我们估计了手术率的种族差异如何影响实际健康结果的差异。5.危重三级老人的医生决策规范。我们使用定性的方法来描述影响急诊室和医院中危重老年人使用维持生命治疗的规范和价值观。我们计划测试一项或多项干预措施的可行性，以改变实践规范，以提高效率为更广泛的目标。核心：核心包括与七家领先医院合作的倡议，以解决为健康和退休研究用户提供护理、数据支持和健康效率措施方面的低效问题。相关性：该项目试图了解为什么美国医疗体系的效率如此之低：30%的医疗支出被浪费，医疗质量严重不足。我们还探讨了几种提高质量和减少不必要的支出差异的方法。

DESCRIPTION (provided by applicant): Our original P01 grant application was motivated by the remarkable differences in health care intensity in the US. In this resubmission, we sharpen our focus in three ways. The goal is to understand and improve efficiency, the target is a more actionable level for physicians and the hospitals where they work, and the means include collaborations with key stakeholders to design successful interventions. The projects are: 1. Measuring the Efficiency of Health Care Providers. This project develops measures of efficiency - both quality and costs - and explores their implications at the level of primary care physicians, physician groups, and hospitals. We use Medicare data, patient and physician surveys, and specialty board certification scores from the American Board of Internal Medicine and the American Board of Family Practice. 2. Causes and Consequences of Variation in Pharmacotherapy Efficiency. We describe and model variation in prescription drug use using longitudinal claims data from very large insurance providers in two states, studying both consequences of variation in prescription drug use in outcomes and the impact of a large, systemic 'shock' - Medicare Part D - on existing treatment patterns and outcomes. 3. Technological Growth and the Efficiency of Health Care Diffusion. We study the contribution of "high- tech" health care to cost growth, the diffusion of different types of medical innovations, whether high-quality health providers affect population-level health outcomes, and how provider networks affect diffusion. 4. Geography and Disparities in Health and Health Care. We propose hospital-level disparity "report cards," to study sorting of patients to disproportionately Black hospitals and to test whether the preferences of patients from a recent nation-wide survey of Medicare enrollees are reflected in their treatments. Finally, we estimate how racial differences in surgical rates affect disparities in actual health outcomes. 5. Norms Governing Physician Decision-Making For Critically III Elders. We use qualitative methods to describe the norms and values that influence the use of life-sustaining treatments among critically ill elders in emergency rooms and hospitals. We plan to test the feasibility of one or more interventions to change practice norms with the broader aim of improving efficiency. Cores: The Cores include an initiative to work with seven leading hospitals to address inefficiency in the provision of care, data support, and health efficiency measures for users of the Health and Retirement Study. Relevance: The project seeks to understand why efficiency is so poor in the U.S. health care system: 30% of health care spending is wasted, and quality of care is seriously lacking. We also explore several approaches to improving quality and reducing unwarranted variations in expenditures.