This proposal is organized around the relationship between delivery system structure, use of PCOR-based evidence, and related clinical and economic outcomes. The central question guiding our proposal is whether differences in the delivery of evidence-based care processes and clinical and economic outcomes can be explained by characteristics of organizations that can be understood and modified, or whether such outcomes are 'residual' characteristics of organizations that are hard to transfer. To address this question, we envision collecting three types of data: an 'enhanced system database' that describes the health system from various perspectives, including hospitals, physicians, and other institutional providers; clinical data from a variety of data bases; and patient and family self-reports about quality of care received. These data will be used in five projects: one examining delivery system characteristics and outcomes nationally; a second focusing on four states with excellent data and diverse health needs (Colorado, Maine, Massachusetts, and Utah); a third and fourth focusing on particular populations where many concerns have been raised about lack of attention to evidence-based care: cancer and pediatrics; and a fifth examining the causes and consequences of corporate integration in dialysis and post-acute care, two industries with major health consequences but which are poorly studied. Major outputs of the project include the construction of new data sets, research papers on these various topics, and disseminating results to market participants and policy makers. Our goal is to learn which features of delivery systems influence the diffusion of evidence-based care, in order to accelerate the quality and value performance of health systems.

Public Health Relevance

This study examines the relationship between characteristics of delivery systems, the delivery of patient centered outcomes research (PCOR)-based evidence, and related clinical and economic outcomes. The overall goal of this study is to learn which features of delivery systems influence the diffusion of evidence based care, in order to accelerate the quality and value performance of health systems.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Program--Cooperative Agreements (U19)
Project #
1U19HS024072-01
Application #
8955131
Study Section
Special Emphasis Panel (ZHS1)
Program Officer
Encinosa, William
Project Start
2015-09-01
Project End
2020-08-31
Budget Start
2015-09-01
Budget End
2016-08-31
Support Year
1
Fiscal Year
2015
Total Cost
Indirect Cost
Name
National Bureau of Economic Research
Department
Type
DUNS #
054552435
City
Cambridge
State
MA
Country
United States
Zip Code
Desai, Sunita; McWilliams, J Michael (2018) Consequences of the 340B Drug Pricing Program. N Engl J Med 378:539-548
Ly, Dan P; Cutler, David M (2018) Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study. J Gen Intern Med 33:1020-1027
Roberts, Eric T; Mehrotra, Ateev; McWilliams, J Michael (2017) High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency. Health Aff (Millwood) 36:855-864
Fowler, Annabelle C; Grabowski, David C; Gambrel, Robert J et al. (2017) Corporate Investors Increased Common Ownership In Hospitals And The Postacute Care And Hospice Sectors. Health Aff (Millwood) 36:1547-1555