MARKET BASED REFORMS AND QUALITY OF CARE

说明：该项目将有两个子项目。第一，他们 是否会研究市场力量的作用-管理式医疗的渗透-在 适当使用血管造影和药物治疗的医疗保险患者， AMI。他们还将研究管理式医疗的普及率和死亡率， 再梗塞该项目将使用来自Cooperative Cardiovascular的数据 计划贝克的市场名称，修改版本的兰德 适当性工具，并与药物治疗指南一致。 他们将采用两步分层模型，第一步是患者 第二是市场层面。通过使用一组更广泛的 协变量，他们将有更好的病例组合调整比其他研究 had. 在第二个项目中，他们将研究护理的质量和结果， 休克，急性胃肠道出血，肺栓塞和急性心肌梗死的竞争变化， 新泽西沿用了1992年的新泽西的利率设定方法。纽约 它将作为一个控制状态。将使用HCUP数据。他们将检查 对AMI患者进行心导管插入术和心脏血管重建术， 消化道出血的内镜检查，栓塞患者的肺血管造影。在 每种情况下，研究的对象是率或可能性，而不是其 适当性结果将包括死亡率。 这四个条件的优点是，他们是专门治疗 如果病人能坚持到那一步的话因此， 没有因住院可能性较低而导致的选择问题，或者 在更严格的医疗保健计划下，将护理转向门诊。 第二个项目基本上是一个前后比较， 同期对照组，以捕捉长期趋势。

Description: This project will have two sub-projects. In the first, they will the examine role of market forces - managed care penetration - in the appropriate use of angiography and drug treatment for Medicare patients with AMI. They will also examine managed care penetration and mortality and reinfarction. This project will use data from Cooperative Cardiovascular Project, Baker?s market designations, a modified version of the RAND appropriateness instrument, and concordance with a guideline for drug therapy. They will employ a two step hierarchical model, with the first being a patient level and the second a market level. By using a more extensive set of covariates, they will have better case-mix adjustment than other studies have had. In the second project, they will look at quality and outcomes of care for shock, acute GI bleed, pulmonary embolus, and AMI as competition changed in New Jersey following the 1992 of New Jersey's rate setting approach. New York will act as a control state. HCUP data will be used. They will examine cardiac catheterization and cardiac revascularization for patients with AMI, endoscopy for GI bleeds, pulmonary angiograms for patients with embolisms. In each case the object of study is the rate or likelihood, not its appropriateness. Outcomes will include mortality. The advantages of these four conditions is that they are exclusively treated in an inpatient setting - if the patient makes it that far. Thus, there should be no selection issues caused by lower likelihood of hospitalization or switching care to outpatient settings under more stringent health care plans. The second project is basically a before and after comparisons with a contemporaneous control group to capture secular trends.