RFA-HS-13-002: Analysis and Dissemination of Patient-Centered Outcomes and its Impact on Patient and Physician Shared Decision-Making Abstract I received my BBA in Economics from the University of North Texas in May 2004 and my PhD in Economics from Indiana University in May 2008, with a focus on game theory and industrial organization. Although my career path in health economics research has been somewhat atypical, including a four-year stent working in litigation consulting, I have been employed as a full-time health economist and researcher at the Baylor Health Care System (BHCS) since January 2012. Prior to joining the BHCS, my research was primarily in the field of applied econometrics and health economics, as well as general research on the impact of information on consumer behavior. Since joining the BHCS, I have had the opportunity to develop my research interests and assist on several projects involving comparative-effectiveness studies, the calculation of bundled payments and value of ACOs, and the appropriate assessment of health-related quality-of-life (HRQOL), with an emphasis to date on adult spinal deformity and more recently cardiology. With the help of the career development grant, I hope to be an independent health economics researcher with a clear focus on three primary research areas: 1) accurate estimation of treatment effects (on average and individual patient groups) and comparative-effectiveness based on currently existing measures of health outcomes, including patient-reported quality-of-life and clinical outcomes;2) determination of the health outcome measures most relevant to patients, families, and clinicians;and 3) the appropriate dissemination of more complete information to patients, families, and clinicians and its impact on physician and patient shared decision-making. Each of these three research areas relate directly to one or more areas in which I have prior publication experience. The first two years of the career development period will be committed to training and applied research in patient-centered outcomes. My training will consist of formal education in patient-centered outcomes measurement and analysis, including coursework from the University of Utah, as well as seminars and webinars as part of health economics conferences, AHRQ, PCORI, and AAMC. My proposed research for the K99 phase of the award concerns the accurate estimation of the comparative-effectiveness of treatment on specific patients or patient groups, with explicit consideration of patient-reported HRQOL outcomes. This research will employ modern econometric analysis to control for self-selection and potential misreporting, and will focus on three primary treatments: spine surgery, hip and knee replacement, and cardiovascular disease. The R00 phase of the award with then focus on the assessment and definition of healthcare value across different patient groups and the practical implications of providing additional information to patients and clinicians prior to undergoing treatment. Through focus groups, the proposed research will first assess the relevance (or irrelevance) of existing outcome measures on patient and physician decision-making. This will provide a more comprehensive metric or series of metrics to gauge the value of healthcare as measured collectively by the preferences of patients, families, clinicians, payers, and other stakeholders. The research will then pursue a randomized controlled trial involving the presentation of predicted health outcomes to candidates for a proposed intervention and a formal study of the impact of such information on the physician/patient interaction and ultimately on the decision to undergo treatment. The proposed research will focus first on patients with diagnosed spine deformity, recruited from the Baylor Scoliosis Center (BSC) and the other 9 member institutions of the International Spine Study Group (ISSG) with which the BSC has a history of collaboration. Future research will also pursue similar aims for patients receiving ICD therapy at the Baylor Health Care System and at other member institutions of the High Value Healthcare Collaborative. In focusing first on spine deformity and spine fusion surgery, the proposed research will address one of the more scrutinized treatments in the clinical and health economics literature, and a treatment for which evidence- based guidelines are sorely lacking. Focusing on spine deformity patients also ensures the feasibility of the research by leveraging my existing relationship and experience with the BSC and the ISSG. Fulfilling the career development plan and proposed research will provide more specific, actionable predictions of patient outcomes and comparative-effectiveness based on existing data, as well as guide future research and clinical practice toward the analysis and dissemination of patient-centered outcomes measures that better assess the value of care as perceived by the patient, family, payer, and clinician.
Spinal deformity has a significant and growing impact on the U.S. healthcare system. The high costs and increasing frequency of spine deformity surgery will continue to impose a large and growing financial burden on the healthcare system, likely rivaling that of low back pain in the future. Coupled with the lack of evidence-based research in this field, there is a critical need for improved health outcomes analysis and measurement, along with an application of these outcomes in clinical decision-making. The purpose of this study is to address three fundamental questions: 1) how should existing data be appropriately analyzed to provide actionable predictions for select patient subgroups;2) how do payers, patients, and clinicians define the value of care;and 3) having identified measures of value from all stakeholders, how should such data be presented to patients and physicians in order to improve shared decision-making? Fulfilling these aims will provide more specific, actionable predictions of patient outcomes based on existing data, as well as guide future research and clinical practice toward the analysis and dissemination of measures that better assess the value of care as perceived by the patient, payer, and clinician.