During the past 10 years, this PPG has focused on documenting persistent inefficiency in U.S. healthcare. Yet we still have an incomplete understanding of the sources of Inefficiency. Nor are our methods and measures adequate to study how policy changes arising in the public or private sector will affects costs and quality. Finally, we are concerned about potential unintended consequences of policy changes adversely affecting vulnerable patients. This PPG application addresses these gaps with 5 distinct subprojects: Healthcare Efficiency among High Need, High Cost Patients. We use Medicare, Medicaid, and nursing home data to study the cost and quality of care for high-need and often high-cost patients within physician-hospital networks. We will study how these high-need patients are affected as healthcare systems evolve - will systems improve the continuity of care for high-need costly patients, or instead seek to shed them? Efficiency of Prescription Drug Use in the Medicare Population. Physician-hospital networks are used to measure differences across patients in their use of efficient and inefficient pharmaceutical use, and the implications for outcomes and downstream costs. We focus on patient cohorts with hip fractures and AMI, as well as under-age-65 disabled Medicare enrollees, African-Americans, and the oldest-old. Understanding and Improving Episode-based Hospital Care. Using a unique dataset on surgery in Michigan hospitals, we seek to understand variations in surgical safety/quality and in healthcare expenditures during the Initial admission and post-discharge. A key question is how Medicare bundled payment reform will affect quality for the over-65, and whether there are spillover effects to the under-65. Measurement and Determinants of Healthcare Efficiency. We estimate models of provider efficiency in static models (with Medicare, Medicaid, and private insurance data when available), between the U.S. and Canada, and with dynamic measures (looking at changes overtime in AMI treatments). Advancing Measures for Risk Adjustment and Performance Assessment. To improve risk adjustment, we develop new health measures from the Health and Retirement Study (HRS) and Medicare. We also pilot patient-reported and biomarker-based measures of health in three sites across the U.S. (Dartmouth, Pennsylvania, and Kaiser Colorado), and further study how feedback to clinicians affects care quality. All 5 subprojects are supported by an Administrative Core, a Data Core, and a Measurement Core.

Public Health Relevance

This proposal seeks to shed light on the following key clinical and policy questions: (a) Who can reasonably be held accountable for the care of high-need patients? (b) Can the value of pharmaceutical treatments in Medicare Part D be Improved? (c) Is better surgical quality more costly? (d) How can we identify efficient health care providers - and are Canadian providers less efficient than those in the U.S? (e) Finally, can we measure health outcomes reliably enough to use In rewarding efficient providers?

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG019783-12
Application #
8588851
Study Section
Special Emphasis Panel (ZAG1-ZIJ-1 (01))
Program Officer
Haaga, John G
Project Start
2001-07-01
Project End
2017-11-30
Budget Start
2013-12-01
Budget End
2014-11-30
Support Year
12
Fiscal Year
2014
Total Cost
$1,771,300
Indirect Cost
$509,897
Name
Dartmouth College
Department
Miscellaneous
Type
Schools of Arts and Sciences
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 :
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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