MEDICAL INNOVATION AND CHANGES IN PRACTICE PATTERNS

本研究的目的是确定管理式护理机制 影响与医疗相关的实践模式的变化， 创新 现有文献表明， 医疗创新的传播是健康水平提高的主要原因 护理支出。因此，了解管理式护理是否 可能会永久改变医疗保健成本的基本趋势 增长需要了解管理式护理如何影响这一过程 通过这种方式，医疗创新被整合到健康的提供中， 护理服务。 我们重点关注1994年至1997年治疗模式的变化， 四种不同分娩方式的冠心病患者 系统. 这些交付系统包括按服务收费的计划， 模式HMO和两个混合模式HMO，每个由一组/工作人员组成 系统和类似于网络模型HMO的系统。它们共同 招收了超过三百万人。 该项目有三个具体 目标：1.确定导致以下变化的因素： CAD患者的实践模式，并评估技术 在造成这些变化中发挥了作用。2.识别的属性 可能影响实践模式的组织 随着时间的推移和新技术扩散的速度而变化。3.到 确定和评估各组织所采取的战略 专门针对影响CAD相关的实践模式， 包括旨在控制CAD相关技术扩散的技术 创新。 本研究将以医师的半结构式访谈为基础 （全科医生和专科医生）、医疗团体的管理人员，以及 计划管理员，并将根据正在进行的 研究测量CAD相关服务的实践模式变化。

The goal of this research is to identify the managed care mechanisms that influence the changes in practice patterns associated with medical innovation. The existing literature suggests that the adoption and diffusion of medical innovations is the primary cause of rising health care expenditures. Therefore, understanding whether managed care is likely to alter permanently the underlying trends in health care cost growth requires understanding how managed care influences the process by which medical innovations are integrated into the delivery of health care services. We focus on changes in treatment patterns between 1994 and 1997 for patients with coronary artery disease (CAD) in four diverse delivery systems. These delivery systems include a fee-for-service plan, an IPA model HMO, and two mixed model HMOs, each comprised of a group/staff system and a system resembling a network model HMO. collectively they enroll over three million individuals. This project has three specific aims: 1. To identify factors that have contributed to changes in practice patterns for CAD patients and assess the role that technology has played in causing those changes. 2. To identify the attributes of the organization that may affect the extent to which practice patterns change over time and the rate at which new technology diffuese. 3. To identify and assess the strategies that organizations have pursued specifically aimed at influencing CAD related practice patterns, including those aimed at controlling diffusion of CAD related innovations. The research will be based on semi-structures interviews of physicians (generalists and specialists), administrators of medical groups, and plan administrators and will be guided by the results of an ongoing study measuring practice patterns changes for CAD related services.