Teryl Nuckols, M.D., M.S.H.S., is an Internist jointly based at the UCLA Division of General Internal Medicine and Health Services Research and the RAND Corporation. She practices hospital medicine and has successfully led or made substantive contributions to several patient-safety and quality-of-care projects, some pertaining to cost issues. Her long-term objective is to better elucidate the relationship between quality/safety problems and economic issues. The purpose of such research is to inform policy makers and others so that they can prioritize quality/safety interventions, understand how to align economic incentives with implementation, and anticipate the consequences of policy decisions on quality/safety and costs. This application describes a plan that will enable her to achieve this objective. First, she requires greater knowledge of microeconomic theory;additional skill in performing cost, cost-effectiveness, and cost-benefit analyses;and a deeper understanding of quality and safety improvement programs. She will acquire this expertise under the guidance of Dr. Jose Escarce (Principal Mentor), Dr. Steven Asch (Co-Mentor), Dr. Emmett Keeler (Contributor), and Dr. Lee Hilborne (Contributor) who have, respectively, extensive experience in health economics, quality assessment methodology, economic evaluation methodology, and hospital-related patient-safety issues. Coursework at the UCLA School of Public Health and RAND Pardee Graduate School will increase her knowledge and skill. Second, her immediate objective is to establish a substantive research program in this area. She will develop an approach to evaluating the effects of hospital-related patient-safety interventions on key stakeholders, including financial effects on payers, employers, hospitals, and physicians, as well as health and financial effects on patients (Specific Aim One). After developing the approach, she will apply it to a widely accepted hospital-related patient-safety intervention, computerized physician order entry, and obtain feedback from stakeholders (Specific Aim Two). This will increase the understanding of barriers to implementation, identify potential policy levers for promoting implementation, and lay the groundwork for similar studies on other interventions. Each year, medical errors harm many hospitalized patients. There are now several strategies for preventing such harm but hospitals and doctors can be reluctant to use them due to the cost. A better understanding of how strategies for improving patient safety would affect hospitals, doctors, insurance companies, employers, and patients would enable policymakers and others to better align financial incentives with improvement.
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