Moral Hazard in Less Invasive Surgical Technology for Coronary Artery Disease

描述（由申请方提供）：本项目的具体目的是研究接受外科干预治疗的冠状动脉疾病（CAD）患者术后行为变化的治疗特异性差异，以及这些行为变化差异对患者健康结局和治疗费用的影响。经皮冠状动脉介入治疗（PCI）--一种较新且侵入性较小的手术--和冠状动脉旁路移植术（CABG）手术是考虑的CAD手术干预措施。问题的行为变化涉及吸烟，缺乏定期运动方案，热量摄入[部分反映在身体质量指数（BMI）和超重/肥胖]和过度饮酒。PCI和CABG患者在这些行为变化上的差异是否可以解释前者的长期生存结局并不比后者好？是否有一个可衡量的影响，对健康的结果，特别是术后医疗费用，需要再干预，死亡率的结果，与这些病人的行为？如果是这样的话，一旦行为改变保持不变，CABG和PCI患者的结局有何不同？假设术后行为变化存在差异，并且通过相对较小侵入性手术PCI治疗CAD的患者将以低于通过更具侵入性的CABG手术治疗的患者的比率投资于健康改善（通过改善行为）。这一假设的基础是，两种不同的手术干预向接受治疗的患者传达了关于CAD严重性的不同信息。由于更严重的身体和心理提醒，那些接受微创技术（PCI）治疗的人平均将比那些接受更具侵入性手术（CABG）治疗的人更少的努力重新分配到健康投资上。该项目将使用来自健康和退休调查/资产和健康动态的数据，在最年长的老人，国家长期护理调查，和国家健康访谈调查。每项调查都将与医疗保险索赔文件和国家死亡指数挂钩。多变量分析将基于差异中差异和倾向评分匹配方法。 公共卫生相关性：如果经皮冠状动脉介入治疗患者的抵消行为（减少健康投资）的假设被证明是正确的，那么有相对便宜和简单的方法来实施补充技术：有针对性的医生咨询，行为特异性患者随访和行为矫正计划。反过来，经皮冠状动脉介入治疗患者的健康状况改善可能导致：生存率提高，再次干预需求减少或延迟，医疗保健支出减少。总体而言，所有这些发展将导致进一步实现与在CAD治疗中引入微创手术技术相关的潜在福利改善。

DESCRIPTION (provided by applicant): The specific aims of this project are to investigate the treatment-specific differences in changes in post-operative behavior of patients who have been treated for coronary artery disease (CAD) with surgical intervention and the effects of these differences in behavior change on patient health outcomes and cost of treatment. Percutaneous coronary intervention (PCI)--the newer and less invasive procedure-- and coronary artery bypass graft (CABG) surgery are the surgical interventions for CAD considered. The behavioral changes at issue pertain to cigarette smoking, the absence of a regular exercise regimen, caloric intakes [reflected in part by body mass index (BMI) and overweight/obese], and excessive alcohol consumption. Can differences in these behavior changes between PCI and CABG patients account for evidence suggesting that long-term survival outcomes are no better for the former than for the latter? Is there a measurable impact on health outcomes, particularly post-operative medical expenditures, the need for reintervention, and mortality outcomes, related to these patient behaviors? If so, how do outcomes differ between CABG and PCI patients once changes in behavior are held constant? The hypothesis is that there are differences in post-operative behavior changes, and that those treated for CAD via the relatively less invasive surgery, PCI, will invest in health improvement (through improved behavior) at lower rates than those treated via the more invasive CABG surgery. This hypothesis is rooted in the idea that the two different surgical interventions convey different information about the seriousness of having CAD to the patient being treated. Due to more serious physical and psychological reminders, those treated with the less invasive technology (PCI) will on average reallocate less effort to health investments than those treated with the more invasive surgery (CABG). The project will employ data from the Health and Retirement Survey/Assets and Health Dynamics Among the Oldest Old, the National Long-Term Care Survey, and the National Health Interview Survey. Each survey will be linked to Medicare claims files and to the National Death Index. The multivariate analysis will be based on difference-in-differences and propensity score matching methods. PUBLIC HEALTH RELEVANCE: If the hypothesis of offsetting behavior (less investment in health) by PCI patients turns out to be correct, there are relatively inexpensive and easy ways to implement complementary technologies: targeted physician counseling, behavior-specific patient follow-up, and behavior modification programs. In turn, improved patient health outcomes for those treated with PCI could result: higher survival rates, a decreased need or delayed need for reintervention, and decreases in medical care spending. Overall all these developments would lead to further realization of the potential welfare improvement associated with the introduction of less invasive surgical technology in the treatment of CAD.