Causes and Consequences of Health Care Efficiency

描述（由申请人提供）：我们最初的P01资助申请是由美国医疗保健强度的显着差异引起的。在这次重新提交中，我们在三个方面加强了我们的重点。目标是了解和提高效率，目标是医生及其所在医院的可操作性更高，手段包括与主要利益攸关方合作，设计成功的干预措施。这些项目是：1；衡量卫生保健提供者的效率。本项目制定了质量和成本两方面的效率衡量标准，并探讨了这些标准对初级保健医生、医生团体和医院的影响。我们使用医疗保险数据，患者和医生调查，以及来自美国内科医学委员会和美国家庭实践委员会的专业委员会认证分数。药物治疗效率变化的原因和后果。我们使用来自两个州的大型保险公司的纵向索赔数据来描述和模拟处方药使用的变化，研究处方药使用结果变化的后果以及医疗保险D部分对现有治疗模式和结果的大规模系统性“冲击”的影响。3. 技术增长与医疗保健扩散的效率。我们研究了“高科技”医疗保健对成本增长的贡献，不同类型医疗创新的扩散，高质量的医疗服务提供者是否影响人口水平的健康结果，以及提供者网络如何影响扩散。4. 健康和保健的地理和差异。我们提出了医院层面的差异“报告卡”，以研究患者在不成比例的黑人医院的分类，并测试最近一项全国范围的医疗保险参保人调查中患者的偏好是否反映在他们的治疗中。最后，我们估计手术率的种族差异如何影响实际健康结果的差异。5. 对ⅲ期危重老年人的医生决策规范。我们使用定性方法来描述影响急诊室和医院危重老年人使用维持生命治疗的规范和价值观。我们计划测试一种或多种干预措施的可行性，以改变实践规范，提高效率的更广泛目标。核心：核心包括一项与七家主要医院合作的倡议，以解决在向健康与退休研究的用户提供护理、数据支持和卫生效率措施方面效率低下的问题。相关性：该项目旨在了解美国医疗保健系统效率如此低下的原因：30%的医疗保健支出被浪费了，医疗质量严重缺乏。我们还探讨了几种提高质量和减少不必要的支出变化的方法。

DESCRIPTION (provided by applicant): Our original P01 grant application was motivated by the remarkable differences in health care intensity in the US. In this resubmission, we sharpen our focus in three ways. The goal is to understand and improve efficiency, the target is a more actionable level for physicians and the hospitals where they work, and the means include collaborations with key stakeholders to design successful interventions. The projects are: 1. Measuring the Efficiency of Health Care Providers. This project develops measures of efficiency - both quality and costs - and explores their implications at the level of primary care physicians, physician groups, and hospitals. We use Medicare data, patient and physician surveys, and specialty board certification scores from the American Board of Internal Medicine and the American Board of Family Practice. 2. Causes and Consequences of Variation in Pharmacotherapy Efficiency. We describe and model variation in prescription drug use using longitudinal claims data from very large insurance providers in two states, studying both consequences of variation in prescription drug use in outcomes and the impact of a large, systemic 'shock' - Medicare Part D - on existing treatment patterns and outcomes. 3. Technological Growth and the Efficiency of Health Care Diffusion. We study the contribution of "high- tech" health care to cost growth, the diffusion of different types of medical innovations, whether high-quality health providers affect population-level health outcomes, and how provider networks affect diffusion. 4. Geography and Disparities in Health and Health Care. We propose hospital-level disparity "report cards," to study sorting of patients to disproportionately Black hospitals and to test whether the preferences of patients from a recent nation-wide survey of Medicare enrollees are reflected in their treatments. Finally, we estimate how racial differences in surgical rates affect disparities in actual health outcomes. 5. Norms Governing Physician Decision-Making For Critically III Elders. We use qualitative methods to describe the norms and values that influence the use of life-sustaining treatments among critically ill elders in emergency rooms and hospitals. We plan to test the feasibility of one or more interventions to change practice norms with the broader aim of improving efficiency. Cores: The Cores include an initiative to work with seven leading hospitals to address inefficiency in the provision of care, data support, and health efficiency measures for users of the Health and Retirement Study. Relevance: The project seeks to understand why efficiency is so poor in the U.S. health care system: 30% of health care spending is wasted, and quality of care is seriously lacking. We also explore several approaches to improving quality and reducing unwarranted variations in expenditures.