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 #
3P01AG019783-18S1
Application #
10138057
Study Section
Special Emphasis Panel (ZAG1)
Program Officer
Bhattacharyya, Partha
Project Start
2001-09-15
Project End
2023-02-28
Budget Start
2020-04-08
Budget End
2021-02-28
Support Year
18
Fiscal Year
2020
Total Cost
Indirect Cost

  Institution

Name
Dartmouth College
Department
Miscellaneous
Type
Graduate Schools
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755

  Publications

Austin, Andrea M; Bynum, Julie P W; Maust, Donovan T et al. (2018) Long-Term Implications Of A Short-Term Policy: Redacting Substance Abuse Data. Health Aff (Millwood) 37:975-979
Likosky, Donald S; Sukul, Devraj; Seth, Milan et al. (2018) Association Between Medicaid Expansion and Cardiovascular Interventions in Michigan. J Am Coll Cardiol 71:1050-1051
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 :

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