The Effect of Provider Market Competition on Patient Health Outcomes in Dialysis

7.项目摘要/摘要 终末期肾病(ESRD)患者尽管使用了大量的 医疗资源共享。控制ESRD护理成本的努力保持质量是很重要的 所提供的护理。由于联邦政府是ESRD服务的主要付款人，政策 由医疗保险和医疗补助服务中心颁布的法案对患者的护理有很大的影响 ESRD。之前对低成本透析的重视促成了十多年的整合 透析提供商市场，导致透析提供商之间的市场竞争从2000年减少到 2010年。目前尚不清楚透析提供商之间的竞争如何影响医疗服务的提供、获得护理的机会以及 透析患者的健康结局。这份K23提案概述了对美国患者的一系列分析。 接受透析：1)检查过去由于透析提供商的整合而减少的竞争 市场影响了以患者为导向的健康结果和病情较重的患者获得护理的机会；2) 检查提供商市场竞争在护理质量、以患者为导向的健康结果以及 在制定了提供“高成本”护理的强有力的财政障碍的情况下获得护理 ESRD预期支付系统(PPS)或支付“捆绑”；以及3)通过直接 患者访谈和标准化问卷，供应商和市场特征如何影响患者 对他们的透析护理和透析提供商的选择感到满意；Kevin F.Erickson博士是一家董事会认证 具有临床肾脏学、卫生服务研究和卫生经济学背景的肾病学家。作为一名 埃里克森博士是斯坦福大学肾脏病、初级保健和结局研究的联合研究员，他的工作 与一个由健康经济学家和临床研究人员组成的多学科团队开始研究经济问题 对肾脏疾病患者的护理很重要。这份职业发展提案是在此基础上提出的 在产业组织经济学方面有持续指导和专心课程的经验， 计量经济学、定性研究、调查和临床试验设计。拟议中的研究有可能 改善肾病患者的健康状况。此外，通过支持规划的职业生涯 发展活动，这个K23奖项将为埃里克森博士提供至关重要的、先进的教学和 作为一名独立的内科医生兼科学家，他在发展自己的职业生涯时接受了体验式培训，研究如何在经济上 激励措施影响--并且可以用来改善--肾病患者的健康结果。

7. Project Summary/Abstract Patients with end-stage renal disease (ESRD) suffer from high morbidity and mortality, despite utilizing a large share of healthcare resources. It is important that efforts to contain the cost of ESRD care preserve the quality of care delivered. Due to the federal government's role as the primary payer for ESRD services, policies enacted by the Centers for Medicare and Medicaid Services have a great influence on the care of patients with ESRD. A prior emphasis on low-cost dialysis has contributed to more than a decade of consolidation in the dialysis provider market, leading to a reduction in market competition among dialysis providers from 2000 to 2010. It is unknown how competition among dialysis providers affects healthcare delivery, access to care, and health outcomes in patients on dialysis. This K23 proposal outlines a series of analyses of patients in the U.S. receiving dialysis: 1) to examine how past decreases in competition due to consolidation in dialysis provider markets has affected patient-oriented health outcomes and access to care among sicker patients; 2) to examine the role of provider market competition on quality of care, patient-oriented health outcomes, and access to care in the setting of strong financial disincentives to provide "higher-cost" care following enactment of the ESRD prospective payment system (PPS) or payment "bundle"; and 3) to examine, through direct patient interviews and standardized questionnaires, how provider and market characteristics influence patients' satisfaction with their dialysis care and choice of dialysis provider; Dr. Kevin F. Erickson is a board certified nephrologist with a background in clinical nephrology, health services research, and health economics. As a joint fellow at Stanford in Nephrology and Primary Care and Outcomes Research, Dr. Erickson has worked with a multidisciplinary team of health economists and clinical investigators to begin studying economic issues important to the care of patients with kidney disease. This career development proposal builds upon this prior experience with continued mentoring and dedicated coursework in industrial organization economics, econometrics, qualitative research, survey and clinical trial design. The proposed study has the potential to improve health outcomes in patients with kidney disease. Additionally, by supporting planned career development activities, this K23 award will provide Dr. Erickson with critically important, advanced didactic and experiential training as he develops his career as an independent physician-scientist studying how economic incentives influence - and can be used to improve - health outcomes in patients with kidney disease.