Analysis and Dissemination of Patient-Centered Outcomes and its Impact on Patient

描述（由申请人提供）：我于2004年5月获得北德克萨斯大学经济学学士学位，并于2008年5月获得印第安纳州大学经济学博士学位，主要研究博弈论和产业组织。虽然我在卫生经济学研究的职业道路有些不典型，包括在诉讼咨询工作四年支架，我一直受雇为贝勒医疗保健系统（BHCS）的全职健康经济学家和研究员自2012年1月以来。在加入BHCS之前，我的研究主要是在应用计量经济学和卫生经济学领域，以及对信息对消费者行为影响的一般研究。自从加入BHCS以来，我有机会发展我的研究兴趣，并协助几个项目，包括比较有效性研究，捆绑支付和ACO价值的计算，以及健康相关生活质量（HRQOL）的适当评估，迄今为止重点是成人脊柱畸形和最近的心脏病学。在职业发展补助金的帮助下，我希望成为一名独立的卫生经济学研究人员，明确关注三个主要研究领域：1）根据目前现有的健康结果指标（包括患者报告的生活质量和临床结果）准确估计治疗效果（平均和个体患者组）和比较有效性; 2）确定治疗效果（平均和个体患者组）。 与患者、家属和临床医生最相关的健康结果指标; 3）向患者、家属和临床医生适当传播更完整的信息，及其对医生和患者共同决策的影响。这三个研究领域中的每一个都与我以前有出版经验的一个或多个领域直接相关。职业发展期的前两年将致力于以患者为中心的成果的培训和应用研究。我的培训将包括以患者为中心的结果测量和分析的正规教育，包括犹他州大学的课程，以及作为卫生经济学会议，AHRQ，PCRI和AAMC的一部分的研讨会和网络研讨会。我为K99阶段的奖项提出的研究涉及对特定患者或患者组治疗的比较有效性的准确估计， 考虑患者报告的HRQOL结局。这项研究将采用现代计量经济学分析来控制自我选择和潜在的误报，并将重点放在三个主要的治疗方法：脊柱手术，髋关节和膝关节置换术，心血管疾病。该奖项的R 00阶段重点关注不同患者群体的医疗保健价值的评估和定义，以及在接受治疗前向患者和临床医生提供额外信息的实际意义。通过焦点小组，拟议的研究将首先评估现有结果措施对患者和医生决策的相关性（或不相关性）。这将提供一个更全面的指标或一系列指标来衡量医疗保健的价值，这些价值是由患者、家庭、临床医生、支付者和其他利益相关者的偏好共同衡量的。然后，该研究将进行一项随机对照试验，包括向候选人介绍预测的健康结果，以进行拟议的干预，并正式研究这些信息对医生/患者互动的影响，并最终决定接受治疗。拟议的研究将首先集中在诊断为脊柱畸形的患者，从贝勒脊柱侧弯中心（BSC）和国际脊柱研究组（ISSG）的其他9个成员机构招募，BSC与之有合作历史。未来的研究还将为在贝勒医疗保健系统和高价值医疗保健合作组织的其他成员机构接受ICD治疗的患者追求类似的目标。首先关注脊柱畸形和脊柱融合手术，拟议的研究将解决临床和卫生经济学文献中更受审查的治疗方法之一，以及严重缺乏循证指南的治疗方法。通过利用我与BSC和ISSG的现有关系和经验，关注脊柱畸形患者也确保了研究的可行性。完成职业发展计划和拟议的研究将提供更具体的，可操作的预测患者的结果和比较有效性的基础上现有的数据，以及指导未来的研究和临床实践，对分析和传播以患者为中心的结果措施，更好地评估护理的价值，由患者，家庭，付款人和临床医生。

DESCRIPTION (provided by applicant): I received my BBA in Economics from the University of North Texas in May 2004 and my PhD in Economics from Indiana University in May 2008, with a focus on game theory and industrial organization. Although my career path in health economics research has been somewhat atypical, including a four-year stent working in litigation consulting, I have been employed as a full-time health economist and researcher at the Baylor Health Care System (BHCS) since January 2012. Prior to joining the BHCS, my research was primarily in the field of applied econometrics and health economics, as well as general research on the impact of information on consumer behavior. Since joining the BHCS, I have had the opportunity to develop my research interests and assist on several projects involving comparative-effectiveness studies, the calculation of bundled payments and value of ACOs, and the appropriate assessment of health-related quality-of-life (HRQOL), with an emphasis to date on adult spinal deformity and more recently cardiology. With the help of the career development grant, I hope to be an independent health economics researcher with a clear focus on three primary research areas: 1) accurate estimation of treatment effects (on average and individual patient groups) and comparative-effectiveness based on currently existing measures of health outcomes, including patient-reported quality-of-life and clinical outcomes; 2) determination of the health outcome measures most relevant to patients, families, and clinicians; and 3) the appropriate dissemination of more complete information to patients, families, and clinicians and its impact on physician and patient shared decision-making. Each of these three research areas relate directly to one or more areas in which I have prior publication experience. The first two years of the career development period will be committed to training and applied research in patient-centered outcomes. My training will consist of formal education in patient-centered outcomes measurement and analysis, including coursework from the University of Utah, as well as seminars and webinars as part of health economics conferences, AHRQ, PCORI, and AAMC. My proposed research for the K99 phase of the award concerns the accurate estimation of the comparative-effectiveness of treatment on specific patients or patient groups, with explicit consideration of patient-reported HRQOL outcomes. This research will employ modern econometric analysis to control for self-selection and potential misreporting, and will focus on three primary treatments: spine surgery, hip and knee replacement, and cardiovascular disease. The R00 phase of the award with then focus on the assessment and definition of healthcare value across different patient groups and the practical implications of providing additional information to patients and clinicians prior to undergoing treatment. Through focus groups, the proposed research will first assess the relevance (or irrelevance) of existing outcome measures on patient and physician decision-making. This will provide a more comprehensive metric or series of metrics to gauge the value of healthcare as measured collectively by the preferences of patients, families, clinicians, payers, and other stakeholders. The research will then pursue a randomized controlled trial involving the presentation of predicted health outcomes to candidates for a proposed intervention and a formal study of the impact of such information on the physician/patient interaction and ultimately on the decision to undergo treatment. The proposed research will focus first on patients with diagnosed spine deformity, recruited from the Baylor Scoliosis Center (BSC) and the other 9 member institutions of the International Spine Study Group (ISSG) with which the BSC has a history of collaboration. Future research will also pursue similar aims for patients receiving ICD therapy at the Baylor Health Care System and at other member institutions of the High Value Healthcare Collaborative. In focusing first on spine deformity and spine fusion surgery, the proposed research will address one of the more scrutinized treatments in the clinical and health economics literature, and a treatment for which evidence- based guidelines are sorely lacking. Focusing on spine deformity patients also ensures the feasibility of the research by leveraging my existing relationship and experience with the BSC and the ISSG. Fulfilling the career development plan and proposed research will provide more specific, actionable predictions of patient outcomes and comparative-effectiveness based on existing data, as well as guide future research and clinical practice toward the analysis and dissemination of patient-centered outcomes measures that better assess the value of care as perceived by the patient, family, payer, and clinician.