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

RFA-HS-13-002：以患者为中心的结局的分析和传播及其对患者的影响 医生共同决策 摘要 我于2004年5月在北德克萨斯大学获得经济学学士学位，并获得经济学博士学位 2008年5月，来自印第安纳州大学，重点是博弈论和产业组织。虽然我的 卫生经济学研究的职业道路有些不典型，包括在 诉讼咨询，我已被聘为全职健康经济学家和研究员在贝勒健康 自2012年1月以来，护理系统（BHCS）。在加入BHCS之前，我的研究主要是在以下领域： 应用计量经济学和卫生经济学，以及关于信息对健康的影响的一般研究。 消费者行为自从加入BHCS以来，我有机会发展我的研究兴趣， 协助若干涉及比较效益研究的项目，计算捆绑付款 和价值，以及对健康相关生活质量（HRQOL）的适当评估， 迄今为止，重点是成人脊柱畸形，最近是心脏病学。 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）准确估计治疗效果（平均和 个体患者组）和基于当前现有健康措施的比较有效性 结果，包括患者报告的生活质量和临床结果; 2）确定健康状况 与患者、家属和临床医生最相关的结局指标; 3）适当传播 向患者、家属和临床医生提供更完整的信息，并将其对医生和患者的影响共享 决策的这三个研究领域中的每一个都直接涉及到我以前研究过的一个或多个领域。 出版经验。 职业发展期的前两年将致力于培训和应用研究， 以患者为中心的结果。我的培训将包括以病人为中心的结果的正规教育 测量和分析，包括犹他州大学的课程，以及研讨会和 网络研讨会作为卫生经济学会议、AHRQ、PCRI和AAMC的一部分。我的研究计划是 该奖项的K99阶段涉及对治疗的比较有效性的准确估计， 特定患者或患者组，明确考虑患者报告的HRQOL结局。这 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， 将集中在三个主要的治疗：脊柱手术，髋关节和膝关节置换，和心血管疾病。 该奖项的R 00阶段，重点是评估和定义医疗保健价值， 不同的患者群体和向患者提供额外信息的实际影响， 临床医生在接受治疗前。通过焦点小组，拟议的研究将首先评估 现有结果测量对患者和医生决策的相关性（或不相关性）。这将 提供更全面的指标或一系列指标，以衡量医疗保健的价值， 由患者、家属、临床医生、付款人和其他利益相关者的偏好共同决定。 然后，该研究将进行一项随机对照试验，包括预测健康状况的介绍。 向候选人提供拟议干预措施的结果，并正式研究这些信息对 医生/患者的互动，并最终决定接受治疗。拟议的研究将 首先关注诊断为脊柱畸形的患者，从贝勒脊柱侧凸中心（BSC）和 国际脊柱研究小组（ISSG）的其他9个成员机构，BSC与之有着悠久的历史， 协作未来的研究也将为在贝勒医院接受ICD治疗的患者追求类似的目标 卫生保健系统和其他成员机构的高价值医疗保健协作。讲 首先是脊柱畸形和脊柱融合手术，拟议的研究将解决一个更 在临床和卫生经济学文献中仔细审查了治疗方法，并且有证据表明- 基本的指导方针是非常缺乏的。对脊柱畸形患者的关注也确保了 利用我与BSC和ISSG的现有关系和经验进行研究。 完成职业发展计划和拟议的研究将提供更具体、可操作的预测 基于现有数据的患者结局和比较有效性，并指导未来的研究 和临床实践的分析和传播以患者为中心的结果的措施，更好地 评估患者、家属、付款人和临床医生所感知的护理价值。

RFA-HS-13-002: Analysis and Dissemination of Patient-Centered Outcomes and its Impact on Patient and Physician Shared Decision-Making Abstract 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.