Causes and Consequences of Health Care Intensity

描述(申请人提供)：1996年，人均医疗保险 明尼阿波利斯的支出为3700美元，迈阿密为7783美元。不同之处： 在不同地区的生命终结模式中观察到了类似的震级 护理，如在医院死亡的机会或不同 在生命的最后6个月里看过的专家。先前的研究表明 这些治疗的地理差异在很大程度上是由于差异 在强度上，即相似患者的治疗方式的差异。 更好地了解区域差异的原因和后果 强度可能会对健康和福祉产生重要影响 老年人，解决健康差距和经济健康 医疗保险信托基金。该项目通过以下方式解决这些问题： 1.衡量病情相似的患者如何得到不同的治疗 关于总体强度和不同维度的跨区域 强度很大。 2.确定强度差异的原因。在多大程度上 它们是由于患者对护理的偏好、医生的信仰或其他因素？ 为什么老年患者在一些地区成为常态，而在另一些地区却不是常态 拥有广泛的CAD诊断测试经验，以及后续的后续测试 程序、专科医生转介和住院？ 3.研究更大的卫生保健强度的后果。什么是 更大强度的护理对结果的影响，包括生存、健康 功能，以及更广泛的幸福感？ 4.寻求了解跨地区或跨地区的医疗保健强度 随着时间的推移，会影响不同社会经济群体在医疗保健方面的差异 治疗方法和结果。 该项目将汇集一个跨学科的研究团队，包括 来自Dawg；港口；缅因州医疗中心；中心的调查人员 马萨诸塞州波士顿调查研究中心、马萨诸塞州综合医院和 国家经济研究局。

DESCRIPTION (provided by applicant): In 1996, average Medicare per capita expenditures were $3,700 in Minneapolis and $7,783 in Miami. Differences of a similar magnitude were observed across regions in patterns of end-of-life care, such as the chances of dying in a hospital or the number of different specialists seen in the last 6 months of life. Previous research indicates that these geographic variations in treatment are due largely to differences in intensity, i.e., differences in the way similar patients are treated. Improved understanding of the causes and consequences of regional variations in intensity could have important implications for the health and well-being of the elderly, for addressing health disparities and for the financial health of the Medicare trust funds. This project addresses these issues by: 1. Measuring how patients of similar illness levels are treated differently across regions with respect to both overall intensity and different dimensions of intensity. 2. Determining the causes of differences in intensity. To what extent are they due to patient preferences for care, physician beliefs, or other factors? Why is it the norm in some regions but not others for elderly patients to experience extensive diagnostic testing for CAD, with subsequent downstream procedures, specialist referrals, and hospitalization? 3. Studying the consequences of greater health care intensity. What is the impact of greater intensity of care on outcomes that include survival, health functioning, and well-being more generally? 4. Seeking to understand how health care intensity, either across regions or over time, affects disparities across socioeconomic groups in health care treatments and outcomes. The project will bring together a cross-disciplinary research team comprised of investigators from the DAWG; the PORT; the Maine Medical Center; the Center for Survey Research in Boston, MA; Massachusetts General Hospital; and the National Bureau of Economic Research.