After decades of excessive growth in health care spending, few would disagree that U.S. healthcare must be reorganized to achieve the same or better patient outcomes at lower cost. As the key decision makers in healthcare, physicians are in large part responsible for growth in healthcare utilization through ordering of imaging, diagnostic tests, procedures, and hospital services. And yet, much remains to be learned about variation in physician practice patterns and the implications of those differences for the outcomes of their patients. More broadly, the body of research quantifying the variation in clinical and economic outcomes across individual physicians is sparse and a greater understanding of the various individual physician and institutional factors that may influence that variation is needed. By combining economic methods with carefully chosen clinical scenarios, I will build a long-term research agenda that seeks to broadly understand factors determining physician practice patterns;the implications of individual practice variations for patient outcomes;and the impact of selected institutional and environmental factors on clinical and economic outcomes of physicians. By linking together a unique set of databases (medical claims of Medicare beneficiaries;demographic and medical training information of the physicians caring for these patients;and malpractice claims of these physicians), the proposed research will comprehensively study the variation and determinants of physician spending, quality of care, and patient outcomes, i.e. the 'anatomy'of physician behavior. In addition to quantifying variation in clinical and economic outcomes across physicians, the proposed research will, for a carefully chosen set of physician activities, assess: (1) how spending, qualit of care, and outcomes relate to physician age, sex, medical training, and practice environment, (2) whether clinical outcomes for physicians that spend more on average are better than those that spend less, (3) how a physician's own malpractice history affects his/her subsequent quality of care, spending, and outcomes, (4) how changes in medical training environments (e.g. mandated reductions in weekly work hours of resident physicians) impact physicians later in their career, and (5) how physician practice patterns respond to the local economic environments in which they practice. The ultimate goal of this research is to provide health policy researchers, physicians, and policymakers the scientific basis for tangible physician-based policies to improve quality of care and reduce wasteful health care spending.

Public Health Relevance

After decades of excessive growth in health care spending, few would disagree that U.S. healthcare must be reorganized to achieve the same or better patient outcomes at lower cost. As the key decision makers in healthcare, physicians are in large part responsible for growth in healthcare utilization and yet much remains to be learned about variation in physician practice patterns, the implications of those differences for patient outcomes, and various individual physician and institutional factors that influence variation. By combining economic methods with carefully chosen clinical scenarios, I will build a long-term research agenda which: (1) studies variation in spending, quality of care, and outcomes across physicians, (2) identifies how physician characteristics, organizational environments, medical education, and economic environments influence physician behavior, and (3) provides health policy researchers, physicians, and policymakers the scientific basis for tangible physician-based policies to improve quality of care and reduce wasteful health care spending.

Agency
National Institute of Health (NIH)
Institute
Office of The Director, National Institutes of Health (OD)
Type
Early Independence Award (DP5)
Project #
1DP5OD017897-01
Application #
8609758
Study Section
Special Emphasis Panel (ZRG1-BBBP-E (53))
Program Officer
Basavappa, Ravi
Project Start
2013-09-26
Project End
2018-08-31
Budget Start
2013-09-26
Budget End
2014-08-31
Support Year
1
Fiscal Year
2013
Total Cost
$423,750
Indirect Cost
$173,750
Name
Harvard University
Department
Administration
Type
Schools of Medicine
DUNS #
047006379
City
Boston
State
MA
Country
United States
Zip Code
02115
Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P et al. (2015) Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. JAMA Intern Med 175:196-204
Jena, Anupam B; Prasad, Vinay; Goldman, Dana P et al. (2015) Mortality and treatment patterns among patients hospitalized with acute cardiovascular conditions during dates of national cardiology meetings. JAMA Intern Med 175:237-44
Jena, Anupam B; Stevens, Warren; McWilliams, J Michael (2014) Turning evidence into practice under payment reform: the new frontier of translational science. J Gen Intern Med 29:1542-5
Prasad, Vinay; Jena, Anupam B (2014) The Peltzman effect and compensatory markers in medicine. Healthc (Amst) 2:170-172
Mangalmurti, Sandeep; Seabury, Seth A; Chandra, Amitabh et al. (2014) Medical professional liability risk among US cardiologists. Am Heart J 167:690-6
Jena, Anupam B; Prasad, Vinay; Romley, John A (2014) Long-term effects of the 2003 ACGME resident duty hour reform on hospital mortality. Mayo Clin Proc 89:1023-5
Seabury, Seth A; Helland, Eric; Jena, Anupam B (2014) Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty. Health Aff (Millwood) 33:2048-56
Lakdawalla, Darius N; Jena, Anupam B; Doctor, Jason N (2014) Careful use of science to advance the debate on the UK Cancer Drugs Fund. JAMA 311:25-6
Abola, M V; Prasad, V; Jena, A B (2014) Association between treatment toxicity and outcomes in oncology clinical trials. Ann Oncol 25:2284-9
Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay (2014) Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency. Health Aff (Millwood) 33:1832-40

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