Hospital-level Variation in Treatment Intensity

描述（由申请人提供）：本提案的目的是为Amber Barnato博士提供过渡到独立研究者的方法和结构。 候选人是匹兹堡大学的一名新助理教授，接受过卫生服务研究方面的奖学金培训。 她的长期职业目标是开展和传播研究，为医疗保险融资政策和向美国老年人提供医疗保健提供信息，这是由于医疗保健技术能力的同步提高以及到2030年65岁以上人口的预期翻一番。 在这个职业奖申请的背景下，其中包含定量和定性方法的明确课程，并有一个非常成功的普通内科部门的机构支持和实践导师博士的承诺。德里克安格斯和朱迪思·拉夫，候选人将研究医院水平的变化在生命的尽头治疗强度。 区域分析表明，迈阿密的老年人在生命的最后6个月里在医疗保健上的花费是明尼阿波利斯老年人的两倍，在此期间入住ICU的可能性是明尼阿波利斯老年人的4倍，但没有任何可衡量的结果。 研究医院，而不是地区，可能会提供更多的信息，因为它们是临床决策的实际制定和最有可能受到影响的地方。然而，关于临终关怀的医院层面研究很少，而且存在的研究仅限于回顾性确定为死者的患者，医院的数据太少而无法更普遍化，或者只关注已经进入ICU的患者。 本研究使用一个具有统一监管和报销结构的单一州以及异常丰富的临床出院数据库，将：1）测量宾夕法尼亚州ICU入院和强化程序使用的医院水平; 2）确定生命结束时强化治疗的医院水平相关性; 3）确定不同医院治疗强度对生存率和住院费用的影响。 这是一个二级数据库分析，通过在医院一级收集原始数据进行补充。 这项研究可能有助于确定政策相关的组织因素，可以影响到改善美国老年人在生命结束时的护理。 该奖项将促进候选人过渡到一个独立的卫生服务研究人员将导致未来资助的研究和质量改进活动在宾夕法尼亚州的医院。

DESCRIPTION (provided by applicant): The purpose of this proposal is to provide Dr. Amber Barnato with the means and structure to transition to an independent investigator. The candidate is a new Assistant Professor at the University of Pittsburgh with fellowship training in health services research. Her long-term career goal is to conduct and disseminate research that informs Medicare financing policy and the delivery of health care to older Americans, motivated by the coincident rise in technological capabilities of health care and the expected doubling of the population over age 65 by 2030. In the context of this career award application, which contains a well-defined curriculum in quantitative and qualitative methods and has the institutional support of a highly successful Division of General Internal Medicine and the commitment of practiced mentors Drs. Derek Angus and Judith Lave, the candidate will study hospital-level variation in treatment intensity at the end of life. Regional analyses demonstrate that elders in Miami spend twice as much on health care in the last 6 months of life as those in Minneapolis and are 4 times more likely to be admitted to an ICU during that period, without any measurable outcome benefit. Studying hospitals, rather than regions, may be more informative since they are where clinical decisions are actually made and most likely to be influenced. Yet there is very little hospital-level research on end-of-life care, and that which exists is limited by focusing only on patients who have been retrospectively identified as decedents, having data on too few hospitals to be more generalizable, or focusing only on patients already admitted to an ICU. Using a single state with uniform regulatory and reimbursement structures and an unusually clinically-rich hospital discharge database, this study will: 1) Measure hospital-level rates of ICU admission and intensive procedure use in Pennsylvania; 2) Identify the hospital-level correlates of intensive treatment at the end of life; and 3) Determine the effects on survival and inpatient costs of varying hospital treatment intensity. This is a secondary database analysis augmented by primary data collection at the hospital level. This research may help to identify policy-relevant organizational factors that can be influenced to improve the care of older Americans at the end of life. This award will facilitate the candidate's transition to an independent health services researcher will lead to future funded studies and quality-improvement activities in Pennsylvania hospitals.