Understanding Variation in the Use of Critical Care Services

描述（由申请人提供）：这个K 08奖将提供一个机会，为候选人，博士科林R。库克，成为一个独立的医生科学家，专注于提高价值和效率的组织，交付和资助的重症监护。在过去的20年里，重症监护服务的使用在美国迅速增长，而与此同时，其目前的使用在不同的地理区域有很大的差异。迄今为止，人们对这种增长和变化的根本驱动因素和影响知之甚少。库克博士的全面计划，以实现以下主要目标：1）更好地确定增长和变化的关键护理利用的原因和影响，以及2）发展独立的卫生服务研究事业。为了实现这些目标，库克博士提出了一个综合课程，其中包括设计、开展和出版与政策有关的卫生服务研究项目的实践经验;课程旨在补充他以前在流行病学和生物统计学方面的研究培训，包括高级生物统计学、卫生筹资和政策以及计量经济学;由卫生保健效率、危重病护理政策和卫生经济学专家进行密集指导;并参加国家科学会议。密歇根大学丰富的学术环境非常适合库克博士的培训，并使他能够组建一个导师委员会，其成员拥有重症监护质量，卫生政策，经济学和生物统计学方面的专业知识。Cooke博士将分析6年以上的按服务付费医疗保险患者，以：1）确定患者类型和卫生系统以及构成重症监护利用率时间和地理变化基础的政策层面因素，2）确定区域重症监护实践模式对死亡率、再住院率和成本的影响。最后，R。库克将检查全州范围内的手术质量合作，以确定重症监护实践模式如何影响术后临床结果。完成拟议的研究将为旨在提高住院设施重症护理效率和协调整个卫生系统重症患者护理的政策提供信息。此外，该项目还有助于候选人过渡到独立的卫生服务调查员，专注于了解和提高重症监护的效率。 公共卫生相关性：该提案的总体目标是描述患者、卫生系统和政策层面的驱动因素以及重症监护服务使用增长和变化的影响。我们的研究结果将被证明与政策制定者直接相关，政策制定者努力调整支付者和医院的激励措施，以鼓励以支持以最低成本实现最大效益的社会目标的方式使用重症监护服务。

DESCRIPTION (provided by applicant): This K08 award will provide an opportunity for the candidate, Dr. Colin R. Cooke, to become an independent physician scientist focused on increasing the value and efficiency in the organization, delivery, and financing of critical care. Over the last 20 years the use of critical care services has grown rapidly in the United States, while at the same its current use varies widely across geographic regions. To date, very little is known about the underlying drivers and implications of such growth and variation. This scientist development application describes Dr. Cooke's comprehensive plan to accomplish the following primary goals: 1) to better identify the causes and implications of growth and variation critical care utilization, and 2) to develop an independent health services research career. To achieve these goals, Dr. Cooke proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing policy-relevant health services research projects; coursework designed to supplement his previous research training in epidemiology and biostatistics consisting of advanced biostatistics, health financing and policy, and econometrics; intensive mentoring by experts in health care efficiency, critical care policy, and health economics; and participating in national scientific meetings. The rich academic environment at the University of Michigan is ideal for Dr. Cooke's training and has allowed him to assemble a mentorship committee whose members possess expertise in critical care quality, health policy, economics, and biostatistics. Dr. Cooke will analyze fee-for-service Medicare patients over 6 years to: 1) identify the types of patients and the health system and policy- level factors that underlie temporal and geographic variation in critical care utilization, and 2) determine the effec of regional critical care practice patterns on mortality, re-hospitalizations, and costs. Finally, r. Cooke will examine a statewide surgical quality collaborative to determine how critical care practice patterns impact post-operative clinical outcomes. Completion of the proposed research will inform policies aimed at improving the efficiency of critical care in inpatient facilities andthe coordination of care for critically ill patients across the health system. In addition this projectwill facilitate the candidate's transition to an independent health services investigator focused on understanding and improving the efficiency of critical care. PUBLIC HEALTH RELEVANCE: The overarching goal of this proposal is to characterize the patient, health system, and policy-level drivers and implications of growth and variation in the use of critical care services. Our results will prove immediately relevant for policymakers strivin to align payer and hospital incentives to encourage the use of critical care services in ways that support societal goals of maximum effectiveness for minimum costs.