We have proposed five projects that together address many of the shortcomings in our understanding of how to measure, study and improve efficiency in healthcare. Core B is responsible for data management and analytic support for the data on which the five projects rest. To understand the causes and consequences of differences in the efficiency of healthcare, it is crucial to have: (1) a comprehensive database with sufficient power to characterize detailed patterns of healthcare utilization at the regional, hospital, physician and network levels, (2) a broad array of additional measures drawn from diverse sources that can augment these data, (3) the analytic capacity and oversight to ensure the timely preparation of analytic datasets, and (4) appropriate access to these resources for other investigators. We plan first to maintain a comprehensive and secure database of administrative data including Medicare and Medicaid enrollment files, claims records, and supplementary files. Second, we hope to obtain and manage additional data files required for this P01 and to develop subproject-specific analytic files. We will obtain data from a variety of sources, including the American Board of Internal Medicine, the Minimum Data Set of nursing home care, and Michigan and Texas Blue Cross Blue Shield data. Third, we seek to maintain a computing infrastructure and procedures capable of managing a high volume of patient identifiable, confidential data while ensuring timely and appropriate access to authorized investigators. And finally, we plan to make the research files developed under this P01 available to the research community to the extent permissible under law.

Public Health Relevance

Medicare, Medicaid and private health plans are all moving toward payment systems intended to reward value: better care and lower costs. This Core is intended to acquire, maintain, and disseminate comprehensive data with innovative measures of cost and quality based on all three payers. These data will be used to study productivity gaps and opportunities to improve efficiency of healthcare.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Dartmouth College
United States
Zip Code
Goodney, Philip P; Tarulli, Massimo; Faerber, Adrienne E et al. (2015) Fifteen-year trends in lower limb amputation, revascularization, and preventive measures among medicare patients. JAMA Surg 150:84-6
Colla, Carrie H; Sequist, Thomas D; Rosenthal, Meredith B et al. (2015) Use of non-indicated cardiac testing in low-risk patients: Choosing Wisely. BMJ Qual Saf 24:149-53
Morden, N E; Schpero, W L; Zaha, R et al. (2014) Overuse of short-interval bone densitometry: assessing rates of low-value care. Osteoporos Int 25:2307-11
Mangalmurti, Sandeep; Seabury, Seth A; Chandra, Amitabh et al. (2014) Medical professional liability risk among US cardiologists. Am Heart J 167:690-6
Chen, Christopher; Scheffler, Gabriel; Chandra, Amitabh (2014) Readmission penalties and health insurance expansions: a dispatch from Massachusetts. J Hosp Med 9:681-7
Schoenfeld, Andrew J; Harris, Mitchel B; Liu, Haiyin et al. (2014) Variations in Medicare payments for episodes of spine surgery. Spine J 14:2793-8
Reames, Bradley N; Shubeck, Sarah P; Birkmeyer, John D (2014) Strategies for reducing regional variation in the use of surgery: a systematic review. Ann Surg 259:616-27
Sirovich, Brenda E; Lipner, Rebecca S; Johnston, Mary et al. (2014) The association between residency training and internists' ability to practice conservatively. JAMA Intern Med 174:1640-8
Lewis, Valerie A; Colla, Carrie H; Schoenherr, Karen E et al. (2014) Innovation in the safety net: integrating community health centers through accountable care. J Gen Intern Med 29:1484-90
Liu, Stephen K; Munson, Jeffrey C; Bell, John-Erik et al. (2014) Response letter to Herbert L. Muncie, Jr. J Am Geriatr Soc 62:998-9

Showing the most recent 10 out of 154 publications