There is a growing consensus that technology growth has been the primary driving force in rising health care costs and has yielded great benefits in functioning and longevity. Yet our understanding of technology growth in health care is rudimentary. For example, why do some regions rapidly adopt highly efficient treatments such as beta blockers for heart attacks (well-established improvements at very low cost), or less efficient treatments such as spinal fusion with instrumentation (small or unknown improvements at higher cost)? Social networks are likely important, but there is minimal understanding of how the environment in which physicians work affects adoption of efficient innovations. Finally, do elderly people in the Health and Retirement Study (MRS) with more efficient health care providers actually experience better outcomes? These questions will be addressed in our 5 specific aims that: 1. Measure what factors have contributed to costs in the Medicare population during the last several decades. Is """"""""technological progress"""""""" primarily new procedures, diffusion across wider population groups, or greater frequency of use for the same patients, and to what extent is """"""""hi-tech"""""""" really high-cost? 2. Develop measures of network referral """"""""density"""""""" from the Medicare claims data. With these measures and with physician certification scores, study the adoption of efficient drug prescription methods using physicianlevel drug prescription data from two states and hospital-level data on beta blocker use from 1994-1995 and 2004-2005. 3. Estimate factors associated with the diffusion of high-cost surgical innovations, particularly those whose efficiency may vary across population groups or providers. We consider angioplasty and bypass surgery for heart attacks, carotid endarterectomy, and spinal fusion. 4. Study the diffusion of new technologies to the oldest-old, including procedures such as cardiac surgery and carotid endarterectomies. How does the marginal effectiveness of these treatments differ from the younger-old, and across regions? 5. Match hospital and provider quality information derived from Medicare claims and other sources data as measured in Project 1 to individual data in the HRS (either by zip code or by individual identifier) to test the hypothesis that the efficiency of health care providers affects the long-term dynamics of health transitions in the general elderly population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG019783-10
Application #
8236948
Study Section
Special Emphasis Panel (ZAG1)
Project Start
Project End
2012-11-30
Budget Start
2011-03-01
Budget End
2013-02-28
Support Year
10
Fiscal Year
2011
Total Cost
$354,267
Indirect Cost
Name
Dartmouth College
Department
Type
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
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 :
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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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