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

描述（由申请方提供）：尽管使用了大量医疗资源，但终末期肾病（ESRD）患者的发病率和死亡率较高。重要的是，努力控制ESRD护理的成本，以保持所提供的护理质量。由于联邦政府作为ESRD服务的主要支付者，医疗保险和医疗补助服务中心制定的政策对ESRD患者的护理有很大的影响。此前对低成本透析的重视促成了透析供应商市场十多年的整合，导致2000年至2010年透析供应商之间的市场竞争减少。目前尚不清楚透析提供商之间的竞争如何影响透析患者的医疗服务、护理获取和健康结局。本K23提案概述了对美国接受透析的患者的一系列分析：1）检查过去由于透析供应商市场整合而导致的竞争减少如何影响以患者为导向的健康结果和病情较重患者的护理; 2）检查供应商市场竞争对护理质量，以患者为导向的健康结果的作用，在ESRD前瞻性支付系统（PPS）或支付“捆绑”颁布后，在强有力的经济抑制因素的背景下提供“高成本”护理;以及3）通过直接患者访谈和标准化问卷调查，研究供应商和市场特征如何影响患者对他们的满意度。 透析护理和透析提供者的选择;埃里克森是一名委员会认证的肾病学家，具有临床肾病学、卫生服务研究和卫生经济学背景。作为斯坦福大学肾脏病学、初级保健和结局研究的联合研究员，埃里克森博士与一个由卫生经济学家和临床研究人员组成的多学科团队合作，开始研究对肾病患者护理重要的经济问题。这一职业发展建议建立在此之前的经验，在工业组织经济学，计量经济学，定性研究，调查和临床试验设计的持续指导和专门的课程。这项拟议的研究有可能改善肾脏疾病患者的健康状况。此外，通过支持计划的职业发展活动，该K23奖项将为埃里克森博士提供至关重要的，先进的教学和经验培训，因为他发展了自己的职业生涯，作为一名独立的医生-科学家，研究经济激励如何影响-并可用于改善-肾脏疾病患者的健康结果。

DESCRIPTION (provided by applicant): 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.