Surgeon Human Capital Depreciation Impacts on Resource Use and Patient Outcomes

描述(由申请人提供)：手术中的时间距离被定义为提供者执行特定程序之间的时间，有证据表明时间距离越长，患者的预后越差。据推测，较长的距离也可能与较大的每位患者的资源使用有关。这个项目的主要目的是检查时间距离和提供者数量对质量的影响，根据患者的结果来衡量，以及在美国医疗保健系统的背景下的效率。我们将研究用于治疗冠状动脉疾病的两种最常见的外科手术，CABG和PCI，以及AAA修复手术，颈动脉内膜切除术和主动脉瓣修复。有两个次要目标。第一个是检查离开手术室一段较长时间后还有多少次手术，时间距离的影响仍然存在。第二是评估特定手术之间的时间距离的影响，因为外科医生的多年经验减轻或加速了这一影响。我们将使用宾夕法尼亚州卫生保健成本控制委员会(PHC4)2006-2009年的住院数据。我们将首先使用基本的Logistic回归建模技术来检查时间距离效应，同时根据患者风险和提供者数量进行调整。然后，我们将使用固定效果建模来处理未观察到的提供者的异构性。本研究旨在探讨时间距离对价值的影响是否存在，以质量和效率来衡量。一旦证明了这些影响的严重性，就可以通过适当的运营权管理战略和许可政策来解决这些问题。此外，我们的研究将为医院区划政策提供参考，到目前为止，这一政策仅基于容量效应。 公共卫生相关性：拟议的研究对公共卫生具有重要影响，因为它涉及与外科护理的质量、安全和效率有关的问题。这项研究的结果可能导致与管理和政策相关的干预措施的设计，从而提高大手术的质量和价值。

DESCRIPTION (provided by applicant): Temporal distance in surgery is defined as the time between a providers performance of a particular procedure, and there is evidence that longer temporal distance is associated with poorer patient outcomes. It is hypothesized that longer distance might also be associated with greater per patient resource use. The primary aim of this project are to examine the impact of temporal distance and provider volume on quality, as measured by patient outcomes, and efficiency in the context of the US medical care system. We are going to examine the two most common surgical procedures used to treat coronary artery disease, CABG and PCI, as well as AAA repair surgery, carotid endarterectomy and aortic valve repair. There are two secondary aims. The first is to examine how many procedures subsequent to a longer period away from the operating room the temporal distance impact remains. The second is to assess the impact of the temporal distance between the specific procedures is either mitigated or accelerated by surgeons' years of experience. We will employ the inpatient data from the Pennsylvania Health Care Cost Containment Council (PHC4) for the years 2006-2009. We will first employ basic logistic regression modeling techniques to examine the temporal distance effect while simultaneously adjusting for patient risk and provider volume. We then will employ fixed effects modeling to deal with the unobserved heterogeneity of the providers. This study is intended to probe for the existence of temporal distance effects on value, as measured by quality and efficiency. Once the magnitude of these effects are demonstrated, they can be addressed by appropriate OR management strategies and licensing policy. In addition our study will inform hospital regionalization policy which to this point has been based solely on volume effects. PUBLIC HEALTH RELEVANCE: The proposed research has important implications for public health as it addresses issues related to the quality, safety and efficiency of surgical care. Results of this research could lead to the design of interventions, both managerial and policy related, that would provide improvements in quality and the value of major surgery.