Physician Level Analysis of Medical Technology Diffusion: Coronary Stents Study

医疗技术扩散的医师水平分析：冠状动脉支架研究

• 批准号: 8530134
• 负责人: PINAR KARACA-MANDIC
• 金额: $ 12.39万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8530134
• 关键词: Address; Admission activity; Adopted; Adoption; Affect; American; American Medical Association; Caring; Characteristics; Clinical; Communities; Coronary; Coronary artery; Data; Databases; Development; Diffuse; Diffusion; Diffusion of Innovation; Disease; Doctor of Philosophy; Drug Approval; Economics; Employment; Exposure to; Funding; Goals; Grant; Health Care Costs; Health Services Research; Hospitals; Incentives; Industry; Inpatients; Insurance; Insurance Coverage; Knowledge; Learning; Life Expectancy; Link; Literature; Marketing; Medical; Medical Technology; Medicare; Medicare claim; Metals; Minnesota; Outcome; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Physician' s Role; Physicians; Play; Population; Positioning Attribute; Productivity; Provider; Research; Research Project Grants; Role; Services; Social Interaction; Social Network; Social Welfare; Socioeconomic Status; Stents; Surveys; Technology; Time; Training; Universities; Variant; Work; Writing; abstracting; career; career development; cost effective; demographics; driving force; field study; geographic difference; health economics; improved; innovation; insight; interest; mortality; new technology; payment; percutaneous coronary intervention; population health; professor; social competition

Summary/Abstract The focus of my PhD training in economics was empirical industrial organization, a field that studies strategic interactions between firms, consumers and other agents in the economy. Since obtaining my PhD, I have started exploring a new field, health economics, first through my employment at RAND, then in my position as an assistant professor at the University of Minnesota. I have explored various topics in health economics to build from scratch a spectrum of expertise and hands-on knowledge in a field brand new for me. A natural next step for my career development is to focus on a research agenda around several important themes that interest me most, and to expand my research knowledge beyond what I have studied thus far. The key themes I would like to focus on are medical innovation and diffusion, the role of incentives at the patient and provider level, and the role of insurance. The proposed study will allow me to:(1) develop expertise in the analysis of Medicare database; (2) build capability in working with large databases; (3) enhance my statistical training; (4) understand diseases and gain clinical insights; (5) improve my ability to develop research projects, and to write grants competitive for funding at the R01 level; (6) expand my exposure to health services research and health economics community; Through the proposed project, I will start building a long-term research agenda focused on understanding the mechanisms underlying the adoption and diffusion of new medical technologies. In most circumstances, physicians are the key agent in determining whether a patient receives a given medical technology, suggesting that understanding the forces that affect physician technology adoption and use is critical to addressing utilization of medical technology. However, physician adoption of medical technology is not well studied or understood. My goal is to investigate how competition, social networks and learning from other physicians affect patterns of physician medical technology adoption in addition to the more traditional explanations such as physician, hospital and patient characteristics. I propose to study the diffusion of medical technology using coronary artery stents in the Medicare population as the exemplar. Linking Medicare claims to physician demographic data from the American Medical Association and to hospital characteristics from the American Hospital Survey: (1) I will document the variation across time, regions, and hospitals in physicians' use of bare-metal, coated and drug eluting stents. (2) I will estimate the role of physician characteristics, competition among physicians, social interactions (including learning from other physicians), and expected patient demographics on the physician's decision to adopt and use new stents. (3) I will estimate the consequences of physicians' use of new stents on patients' outcomes following stent insertion, such as rates of re-admissions, repeat percutaneous coronary interventions (PCI), and mortality.

摘要/摘要 我的经济学博士培训的重点是经验工业组织，该领域研究 经济中的公司，消费者和其他代理商之间的战略互动。自获得博士学位以来，我 首先是通过我在兰德的工作，然后在我的 在明尼苏达大学担任助理教授。我探索了健康的各种主题 从头开始，从头开始，从头开始建立一系列专业知识和动手知识的经济学。 我职业发展的自然下一步是专注于几个重要的研究议程 主题最感兴趣，并将我的研究知识扩展到迄今为止所研究的主题。这 我想关注的关键主题是医疗创新和扩散，激励措施在患者中的作用 和提供者级别以及保险的作用。拟议的研究将使我能够：（1）在 Medicare数据库的分析； （2）在使用大型数据库中建立能力； （3）增强我的统计 训练; （4）了解疾病并获得临床见解； （5）提高我开发研究项目的能力， 并在R01水平上写赠款的资金竞争； （6）扩大我对卫生服务的接触 研究与健康经济学社区； 通过拟议的项目，我将开始建立一个重点了解理解的长期研究议程 采用和扩散新医疗技术的基础机制。在大多数情况下， 医师是确定患者是否接受给定的医疗技术的关键剂 理解影响医师技术采用和使用的力量对于解决问题至关重要 医疗技术的利用。但是，医师对医疗技术的采用尚未得到很好的研究或 理解。我的目标是调查竞争，社交网络和向其他医生学习 除了更传统的解释之外，会影响医生技术采用的模式 作为医师，医院和患者特征。 我建议使用冠状动脉支架在Medicare中研究医疗技术的扩散 人口作为典范。将Medicare主张与美国的医师人口数据联系起来 医学协会和美国医院调查的医院特征：（1）我将记录 时间，区域和医院的差异是医生使用裸金属，涂层和药物洗脱支架的变化。 （2）我将估计医师特征，医师之间的竞争，社会互动的作用 （包括向其他医生学习），以及关于医生决定的患者人口统计学的预期 采用并使用新支架。 （3）我将估计医生使用新支架对患者的后果” 支架插入后的结果，例如重新入场率，重复经皮冠状动脉干预措施 （PCI）和死亡率。