Physician Organization and the Efficiency of Surgical Specialty Care

描述(由申请人提供)：更好地了解医生组织与医疗质量和成本之间的关系，将极大地促进围绕医疗保险计划中责任医疗组织(Aco)实施的政策辩论。在此背景下，候选人(大卫·C·米勒博士)寻求评估美国外科实践的组织及其与效率的关系。这位候选人是密歇根大学的一名泌尿科医生和卫生服务研究员，他将利用这一提议扩大他的研究议程的科学和临床范围，并促进他成为一名独立的调查员。在支持期间，他将继续在几个学科进行额外的教学，包括高级统计和计量经济学方法(例如，分层建模)、医疗保健组织和医疗保健政策方面的博士级课程。他还将有大量机会接受指导，进行基于项目的学习，包括实践应用先进的统计建模和计量经济学技术。该研究计划有三个目标：目标1。了解美国外科实践的组织情况。使用行政和调查数据，候选人将确定在四个不同的组织环境中提供的外科护理的比例：1)综合交付系统，2)多专科小组，3)单一专科小组，以及4)单独或2人实践。他还将探索医生组织和效率的潜在决定因素之间的关系，包括财政激励和护理协调策略的使用。目的2.探讨医生组织与外科护理质量的关系。使用国家医疗保险索赔数据(2006-2008年)，候选人将比较风险调整后的手术死亡率、再住院率和手术后并发症，这些患者正在接受由在相同四个组织机构工作的外科医生进行的常见住院手术。他认为，在综合交付系统中工作的外科医生将会有更好的结果，部分原因是他们有更强的信息交换和护理协调能力。目的3.评价医生组织与外科医疗费用的关系。最后，对于相同的医生组织，候选人将比较与外科护理的索引事件相关的医疗保险支出。待评估的具体成本包括(除其他外)整体医院付款、医生服务付款和急性后护理付款。他假设，单一专科诊所的外科医生将提供更昂贵的护理，其中包括更多地使用顾问、诊断测试和出院后辅助护理。拟议研究的完成将阐明医疗保险ACO的潜在质量和成本影响，并阐明自愿ACO实施战略的优点。 公共卫生相关性：这项提案将评估美国目前外科实践的组织及其与外科护理质量和成本的关系。我们的发现将被证明与寻求更好地理解联邦医疗保险责任护理组织(ACO)的质量和成本影响以及自愿实施ACO战略的相对优点的政策制定者立即相关。

DESCRIPTION (provided by applicant): Policy debates surrounding implementation of Accountable Care Organizations (ACOs) in the Medicare program would be informed greatly by a better understanding of the relationship between physician organization and the quality and cost of care. In this context, the candidate (Dr. David C. Miller) seeks to evaluate the organization of surgical practice in the United States and its relationship to efficiency. The candidate, a urologist and health services researcher at the University of Michigan, will leverage this proposal to broaden the scientific and clinical scope of his research agenda, and to facilitate his development into an independent investigator. During the period of support, he will pursue additional didactic instruction in several disciplines, including doctoral-level courses in advanced statistical and econometric methods (e.g., hierarchical modeling), health care organizations, and health care policy. He will also have ample opportunities for mentored, project-based learning, including the hands-on application of advanced statistical modeling and econometric techniques. The research plan has three aims: Aim 1. To understand the organization of surgical practice in the United States. Using both administrative and survey data, the candidate will determine the proportion of surgical care provided in four distinct organizational settings: 1) integrated delivery systems, 2) multispecialty groups, 3) single- specialty groups, and 4) solo or 2-person practices. He will also explore the relationship between physician organization and potential determinants of efficiency, including financial incentives and use of care coordination strategies. Aim 2. To examine the relationship between physician organization and quality of surgical care. Using national Medicare claims data (2006-2008), the candidate will then compare risk-adjusted operative mortality, rates of readmission, and post-operative complications among patients undergoing common inpatient procedures performed by surgeons working in the same four organizational settings. He posits that surgeons working in integrated delivery systems will have better outcomes, due in part to their greater capacity for information exchange and care coordination. Aim 3. To evaluate the relationship between physician organization and costs of surgical care. Finally, for the same physician organizations, the candidate will compare Medicare expenditures related to the index episode of surgical care. Specific costs to be assessed include (among others) overall hospital payments, payments for physician services, and payments for post-acute care. He hypothesizes that surgeons in single-specialty practices will provide more expensive care based on, among other factors, greater use of consultants, diagnostic tests, and post-discharge ancillary care. Completion of the proposed research will illuminate the potential quality and cost implications of Medicare ACOs and clarify the merits of a voluntary ACO implementation strategy. PUBLIC HEALTH RELEVANCE: This proposal will evaluate the current organization of surgical practice in the United States and its relationship to the quality and cost of surgical care. Our findings will prove immediately relevant to policymakers seeking to better understand both the quality and cost implications of Medicare Accountable Care Organizations (ACO) and the relative merits of a voluntary ACO implementation strategy.