There is a growing consensus that technology growth has been the primary driving force in rising health care costs and has yielded great benefits in functioning and longevity. Yet our understanding of technology growth in health care is rudimentary. For example, why do some regions rapidly adopt highly efficient treatments such as beta blockers for heart attacks (well-established improvements at very low cost), or less efficient treatments such as spinal fusion with instrumentation (small or unknown improvements at higher cost)? Social networks are likely important, but there is minimal understanding of how the environment in which physicians work affects adoption of efficient innovations. Finally, do elderly people in the Health and Retirement Study (MRS) with more efficient health care providers actually experience better outcomes? These questions will be addressed in our 5 specific aims that: 1. Measure what factors have contributed to costs in the Medicare population during the last several decades. Is """"""""technological progress"""""""" primarily new procedures, diffusion across wider population groups, or greater frequency of use for the same patients, and to what extent is """"""""hi-tech"""""""" really high-cost? 2. Develop measures of network referral """"""""density"""""""" from the Medicare claims data. With these measures and with physician certification scores, study the adoption of efficient drug prescription methods using physicianlevel drug prescription data from two states and hospital-level data on beta blocker use from 1994-1995 and 2004-2005. 3. Estimate factors associated with the diffusion of high-cost surgical innovations, particularly those whose efficiency may vary across population groups or providers. We consider angioplasty and bypass surgery for heart attacks, carotid endarterectomy, and spinal fusion. 4. Study the diffusion of new technologies to the oldest-old, including procedures such as cardiac surgery and carotid endarterectomies. How does the marginal effectiveness of these treatments differ from the younger-old, and across regions? 5. Match hospital and provider quality information derived from Medicare claims and other sources data as measured in Project 1 to individual data in the HRS (either by zip code or by individual identifier) to test the hypothesis that the efficiency of health care providers affects the long-term dynamics of health transitions in the general elderly population.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Dartmouth College
United States
Zip Code
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
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Outcomes of Elective Cerebral Aneurysm Treatment Performed by Attending Neurosurgeons after Night Work. Neurosurgery 82:329-334
Jeffery, Molly Moore; Hooten, W Michael; Henk, Henry J et al. (2018) Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study. BMJ 362:k2833
Jeffery, Molly Moore; Hooten, W Michael; Hess, Erik P et al. (2018) Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use. Ann Emerg Med 71:326-336.e19
Finkelstein, Amy; Ji, Yunan; Mahoney, Neale et al. (2018) Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care: Interim Analysis of the First Year of a 5-Year Randomized Trial. JAMA 320:892-900
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State. Br J Neurosurg 32:13-17

Showing the most recent 10 out of 263 publications