Physician Organization and the Efficiency of Surgical Specialty Care

描述（由申请人提供）：围绕在医疗保险计划中实施责任医疗组织（ACO）的政策辩论将通过更好地了解医生组织与医疗质量和成本之间的关系而得到极大的启发。在这种情况下，候选人（大卫C博士）。米勒）寻求评估组织的外科实践在美国及其关系的效率。候选人是密歇根大学的泌尿科医生和卫生服务研究员，他将利用这一提议来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研究者。在支持期间，他将在几个学科进行额外的教学指导，包括高级统计和计量经济学方法的博士课程（例如，分层建模）、医疗保健组织和医疗保健政策。他还将有充足的机会进行指导，基于项目的学习，包括先进的统计建模和计量经济学技术的实践应用。研究计划有三个目标：目标1。了解美国的外科实践组织。使用管理和调查数据，候选人将确定在四种不同的组织环境中提供的外科护理比例：1）综合交付系统，2）多专业组，3）单专业组，以及4）单人或双人实践。他还将探讨医生组织和效率的潜在决定因素之间的关系，包括财政激励和使用护理协调策略。目标二。探讨医师组织与外科照护品质之关系。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，再入院率，以及在相同的四个组织环境中工作的外科医生进行普通住院手术的患者的术后并发症。他认为，在综合输送系统中工作的外科医生将有更好的结果，部分原因是他们有更强的信息交换和护理协调能力。目标3。探讨医师组织与手术费用之关系。最后，对于相同的医生组织，候选人将比较与手术护理的索引事件相关的医疗保险支出。需要评估的具体成本包括（除其他外）医院总付款、医生服务付款和急性期后护理付款。他假设，在单一专业实践中，外科医生将提供更昂贵的护理，除其他因素外，更多地使用顾问，诊断测试和出院后的辅助护理。完成拟议的研究将阐明医疗保险ACO的潜在质量和成本影响，并澄清自愿ACO实施策略的优点。

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.