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.

Public Health 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.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
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Special Emphasis Panel (ZAG1-ZIJ-9 (O3))
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Haaga, John G
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Dartmouth College
Schools of Arts and Sciences
United States
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Bekelis, Kimon; Gottlieb, Dan; Labropoulos, Nicos et al. (2017) The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms. J Neurosurg 126:29-35
Nyweide, David J; Bynum, Julie P W (2017) Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults. Ann Emerg Med 69:407-415.e3
Chandra, Amitabh; Frakes, Michael; Malani, Anup (2017) Challenges To Reducing Discrimination And Health Inequity Through Existing Civil Rights Laws. Health Aff (Millwood) 36:1041-1047
Bekelis, Kimon; Skinner, Jonathan; Gottlieb, Daniel et al. (2017) De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study. BMJ 359:j4695
Bekelis, Kimon; Gottlieb, Daniel J; Su, Yin et al. (2017) Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms. J Neurosurg 126:811-818
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A et al. (2017) Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State? World Neurosurg 103:852-858.e1
Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2017) Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis. World Neurosurg :
Norton, Edward C; Li, Jun; Das, Anup et al. (2017) Moneyball in Medicare. J Health Econ :
Regenbogen, Scott E; Cain-Nielsen, Anne H; Norton, Edward C et al. (2017) Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults. JAMA Surg 152:e170123
Missios, Symeon; Bekelis, Kimon (2017) Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay. Neurosurgery :

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