Causes and Consequences of Healthcare Efficiency - Akre Diversity

医疗效率的原因和后果：综述 美国医疗保健支出创历史新高，但预期寿命却停滞不前，这引发了人们对 预计的支出增长不会带来相应的健康收益。这是一个问题，尤其与 老年人，疾病负担重，大量使用医疗保健。在此P01续期申请中，我们 建议继续我们长期的工作，通过以下方式确定美国医疗保健的效率和低效 将复杂的经验方法应用于超过10亿人年的健康数据。我们的地址为3 卫生保健提供效率不可或缺的主题：首先，我们对临床决策中挑战的探索 预计将查明有效护理的系统性使用不足和无效护理的过度使用，并提供 缺乏临床试验的证据。第二，我们将研究卫生保健服务的作用 环境--患者共享网络、支付模式和法规如何影响患者健康？第三, 通过我们的多方付款人数据，我们试图了解政策分析的局限性，因为重点是 只有联邦医疗保险或私人(商业)数据。例如，我们试图衡量商业支付有多高 费率会影响联邦医疗保险或医疗补助参保人的准入。所有项目都旨在衡量和提高护理质量 适用于老年、脆弱人群，包括阿尔茨海默病和相关痴呆症患者。 我们提出了3个核心和5个项目。核心A提供行政支持，核心B协调数据； 而核心C(方法)开发了用于所有5个项目的网络分析的新方法。在项目1中， “阿尔茨海默病临床诊断的相关性和后果”，我们使用100% 医疗保险档案和临床丰富的调查数据，以记录ADRD诊断中的变异，并测试是否及早 在网上，诊断对患者是有益的。项目2，“危险报道的原因和后果” 使用Medicare Part D处方药数据来研究与个别药物和药物相关的不良后果 包括阿片类镇痛剂、苯二氮卓类药物和镇静催眠药的组合。我们认为力量 影响高风险处方，如共享患者网络和法律限制。项目3，“确定 高效的医疗服务提供者：来自医院关闭和注册数据的证据“使用外周血管 疾病(PAD)登记数据和索赔数据，以估计社区医院的相关专业知识。这 该项目将通过自然实验(医院关闭)和正在进行的随机试验来验证方法。 项目4，“公共和私人付款率差异的原因和后果”，假设 较高的商业报销率可能会对医疗保险和医疗补助患者的护理机会产生负面影响。 最后，项目5，“医生认知、住院提前护理计划和老年重症患者的结局” 在250个社区中使用了观察性和实验性(随机试验)相结合的研究 提高全美医院的住院医生决策质量。

Causes and Consequences of Healthcare Efficiency: Overview U.S. health care spending is at an all-time high, yet life expectancy is stagnant, raising concerns that projected spending growth won’t lead to commensurate health gains. This is a problem especially pertinent to older adults, with a high burden of illness and intense use of health care. In this P01 renewal application, we propose to continue our long-standing work identifying efficiency and inefficiency in U.S. health care by applying sophisticated empirical methods to more than 1 billion person-years of health data. We address 3 topics integral to health care delivery efficiency: First, our exploration of challenges in clinical decision making is expected to identify systematic underuse of effective care and overuse of ineffective care, and provide evidence where clinical trials are lacking. Second, we will examine the role of the health care delivery environment – how do patient-sharing networks, payment models, and regulations affect patient health? Third, through our multi-payer data, we seek to understand the limitations of policy analysis arising from a focus on just Medicare or private (commercial) data. For example, we seek to measure how high commercial payment rates affect access for Medicare or Medicaid enrollees. All projects aim to measure and improve quality of care for older, vulnerable populations, including people with Alzheimer’s Disease and related dementia (ADRD). We propose 3 cores and 5 projects. Core A provides administrative support, Core B coordinates data; and Core C (Methods) develops new approaches to network analysis used in all 5 projects. In Project 1, “Correlates and Consequences of Making an Alzheimer’s Disease Clinical Diagnosis,” we use the 100% Medicare files and clinically rich survey data to document variation in ADRD diagnosis, and test whether early diagnosis is, on net, beneficial to patients. Project 2, “The Causes and Consequences of Risky Prescribing,” uses Medicare Part D prescription data to study adverse outcomes associated with individual drugs and drug combinations including opioid analgesics, benzodiazepines, and sedative hypnotics. We consider forces influencing high-risk prescribing, such as shared-patient networks and legal restrictions. Project 3, “Identifying Efficient Health Care Providers: Evidence from Hospital Closures and Registry Data” uses peripheral vascular disease (PAD) registry data, and claims data, to estimate the relative expertise of community hospitals. This project will validate methods with natural experiments (hospital closing) and an ongoing randomized trial. Project 4, “Causes and Consequences of Variation in Public and Private Payment Rates,” hypothesizes that high commercial reimbursement rates can negatively affect access to care for Medicare and Medicaid patients. Finally, Project 5, “Physician Cognition, Inpatient Advance-Care Planning, and Outcomes for Seriously Ill Older Adults,” uses a combination of observational and experimental (randomized-trial) research in 250 community hospitals across the U.S. to improve the quality of inpatient physician decision-making.