Abstract

CAUSESANDCONSEQUENCESOFHEALTHCAREEFFICIENCY:OVERVIEW U.S.healthcarespendingisatanall-timehigh,yetlifeexpectancyisstagnant,raisingconcernsthat projectedspendinggrowthwon?tleadtocommensuratehealthgains.Thisisaproblemespeciallypertinentto olderadults,withahighburdenofillnessandintenseuseofhealthcare.InthisP01renewalapplication,we proposetocontinueourlong-standingworkidentifyingefficiencyandinefficiencyinU.S.healthcareby applyingsophisticatedempiricalmethodstomorethan1billionperson-yearsofhealthdata.Weaddress3 topicsintegraltohealthcaredeliveryefficiency:First,ourexplorationofchallengesinclinicaldecisionmaking isexpectedtoidentifysystematicunderuseofeffectivecareandoveruseofineffectivecare,andprovide evidencewhereclinicaltrialsarelacking.Second,wewillexaminetheroleofthehealthcaredelivery environment?howdopatient-sharingnetworks,paymentmodels,andregulationsaffectpatienthealth?Third, throughourmulti-payerdata,weseektounderstandthelimitationsofpolicyanalysisarisingfromafocuson justMedicareorprivate(commercial)data.Forexample,weseektomeasurehowhighcommercialpayment ratesaffectaccessforMedicareorMedicaidenrollees.Allprojectsaimtomeasureandimprovequalityofcare forolder,vulnerablepopulations,includingpeoplewithAlzheimer?sDiseaseandrelateddementia(ADRD). Wepropose3coresand5projects.CoreAprovidesadministrativesupport,CoreBcoordinatesdata;? andCoreC(Methods)developsnewapproachestonetworkanalysisusedinall5projects.InProject1, ?CorrelatesandConsequencesofMakinganAlzheimer?sDiseaseClinicalDiagnosis,?weusethe100% MedicarefilesandclinicallyrichsurveydatatodocumentvariationinADRDdiagnosis,andtestwhetherearly diagnosisis,onnet,beneficialtopatients.Project2,?TheCausesandConsequencesofRiskyPrescribing,? usesMedicarePartDprescriptiondatatostudyadverseoutcomesassociatedwithindividualdrugsanddrug combinationsincludingopioidanalgesics,benzodiazepines,andsedativehypnotics.Weconsiderforces influencinghigh-riskprescribing,suchasshared-patientnetworksandlegalrestrictions.Project3,?Identifying EfficientHealthCareProviders:EvidencefromHospitalClosuresandRegistryData?usesperipheralvascular disease(PAD)registrydata,andclaimsdata,toestimatetherelativeexpertiseofcommunityhospitals.This projectwillvalidatemethodswithnaturalexperiments(hospitalclosing)andanongoingrandomizedtrial. Project4,?CausesandConsequencesofVariationinPublicandPrivatePaymentRates,?hypothesizesthat highcommercialreimbursementratescannegativelyaffectaccesstocareforMedicareandMedicaidpatients. Finally,Project5,?PhysicianCognition,InpatientAdvance-CarePlanning,andOutcomesforSeriouslyIllOlder Adults,?usesacombinationofobservationalandexperimental(randomized-trial)researchin250community hospitalsacrosstheU.S.toimprovethequalityofinpatientphysiciandecision-making.

Public Health Relevance

WeproposetocontinueandextendtheDartmouthP01?slong-standingworktoidentifyandreduceU.S.health careinefficiency.Usingmorethan1billionperson-yearsofhealthdata,weplantotestforsystematicunderuse ofeffectivecareandoveruseofineffectivecare,andtoprovideevidencewhereclinicaltrialdataarelacking. Our5projectsand3coresleveragenetworkanalysis,detailedsurveydata,naturalexperimentssuchas hospitalclosingsandpriceshifts,andaclinicalintervention,tomeasureandimprovethequalityofcarefor olderadults,withaparticularfocusonpeoplewithAlzheimer?sDiseaseandrelateddementia(ADRD).

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
2P01AG019783-16
Application #
9490971
Study Section
Special Emphasis Panel (ZAG1)
Program Officer
Bhattacharyya, Partha
Project Start
2001-09-15
Project End
2023-02-28
Budget Start
2018-05-01
Budget End
2019-02-28
Support Year
16
Fiscal Year
2018
Total Cost
Indirect Cost

  Institution

Name
Dartmouth College
Department
Miscellaneous
Type
Graduate Schools
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code

  Publications

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
Mainor, Alexander J; Morden, Nancy E; Smith, Jeremy et al. (2018) ICD-10 Coding Will Challenge Researchers: Caution and Collaboration may Reduce Measurement Error and Improve Comparability Over Time. Med Care :

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