Our original P01 grant application was motivated by the remarkable differences in health care intensity in the US. In this resubmission, we sharpen our focus in three ways. The goal is to understand and improve efficiency, the target is a more actionable level for physicians and the hospitals where they work, and the means include collaborations with key stakeholders to design successful interventions. The projects are: 1. Measuring the Efficiency of Health Care Providers. This project develops measures of efficiency - both quality and costs - and explores their implications at the level of primary care physicians, physician groups, and hospitals. We use Medicare data, patient and physician surveys, and specialty board certification scores from the American Board of Internal Medicine and the American Board of Family Practice. 2. Causes and Consequences of Variation in Pharmacotherapy Efficiency. We describe and model variation in prescription drug use using longitudinal claims data from very large insurance providers in two states, studying both consequences of variation in prescription drug use in outcomes and the impact of a large, systemic 'shock' - Medicare Part D - on existing treatment patterns and outcomes. 3. Technological Growth and the Efficiency of Health Care Diffusion. We study the contribution of """"""""high- tech"""""""" health care to cost growth, the diffusion of different types of medical innovations, whether high-quality health providers affect population-level health outcomes, and how provider networks affect diffusion. 4. Geography and Disparities in Health and Health Care. We propose hospital-level disparity """"""""report cards,"""""""" to study sorting of patients to disproportionately Black hospitals and to test whether the preferences of patients from a recent nation-wide survey of Medicare enrollees are reflected in their treatments. Finally, we estimate how racial differences in surgical rates affect disparities in actual health outcomes. 5. Norms Governing Physician Decision-Making For Critically III Elders. We use qualitative methods to describe the norms and values that influence the use of life-sustaining treatments among critically ill elders in emergency rooms and hospitals. We plan to test the feasibility of one or more interventions to change practice norms with the broader aim of improving efficiency. Cores: The Cores include an initiative to work with seven leading hospitals to address inefficiency in the provision of care, data support, and health efficiency measures for users of the Health and Retirement Study. Relevance: The project seeks to understand why efficiency is so poor in the U.S. health care system: 30% of health care spending is wasted, and quality of care is seriously lacking. We also explore several approaches to improving quality and reducing unwarranted variations in expenditures.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
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Special Emphasis Panel (ZAG1-ZIJ-9 (O3))
Program Officer
Haaga, John G
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Dartmouth College
Schools of Arts and Sciences
United States
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Bekelis, Kimon; Chang, Chiang-Hua; Malenka, David et al. (2018) Direct oral anticoagulant and antiplatelet combination therapy: Hemorrhagic events in coronary artery stent recipients. J Clin Neurosci 50:24-29
Kelley, Amy S; Bollens-Lund, Evan; Covinsky, Kenneth E et al. (2018) Prospective Identification of Patients at Risk for Unwarranted Variation in Treatment. J Palliat Med 21:44-54
Bekelis, Kimon; Missios, Symeon; Shu, Joel et al. (2018) Surgical outcomes for patients diagnosed with dementia: A coarsened exact matching study. J Clin Neurosci 53:160-164
Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2018) Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis. World Neurosurg 110:e689-e698
Missios, Symeon; Bekelis, Kimon (2018) Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay. Neurosurgery 82:372-377
Ouayogodé, Mariétou H; Meara, Ellen; Chang, Chiang-Hua et al. (2018) Forgotten patients: ACO attribution omits those with low service use and the dying. Am J Manag Care 24:e207-e215
Rosenthal, Meredith B; Colla, Carrie H; Morden, Nancy E et al. (2018) Overuse and insurance plan type in a privately insured population. Am J Manag Care 24:140-146
Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2018) Emergency medical services for acute ischemic stroke: Hub-and-spoke model versus exclusive care in comprehensive centers. J Clin Neurosci :
Chen, Lena M; Ryan, Andrew M; Shih, Terry et al. (2018) Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care. Health Serv Res 53:632-648
Moen, Erika L; Bynum, Julie P; Austin, Andrea M et al. (2018) Assessing Variation in Implantable Cardioverter Defibrillator Therapy Guideline Adherence With Physician and Hospital Patient-sharing Networks. Med Care 56:350-357

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