Physician Organization and the Efficiency of Surgical Specialty Care

医生组织和外科专科护理的效率

• 批准号: 8238122
• 负责人: David C Miller
• 金额: $ 15.53万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8238122
• 关键词: Physician; Organization; Efficiency; Surgical; Specialty

DESCRIPTION (provided by applicant): Policy debates surrounding implementation of Accountable Care Organizations (ACOs) in the Medicare program would be informed greatly by a better understanding of the relationship between physician organization and the quality and cost of care. In this context, the candidate (Dr. David C. Miller) seeks to evaluate the organization of surgical practice in the United States and its relationship to efficiency. The candidate, a urologist and health services researcher at the University of Michigan, will leverage this proposal to broaden the scientific and clinical scope of his research agenda, and to facilitate his development into an independent investigator. During the period of support, he will pursue additional didactic instruction in several disciplines, including doctoral-level courses in advanced statistical and econometric methods (e.g., hierarchical modeling), health care organizations, and health care policy. He will also have ample opportunities for mentored, project-based learning, including the hands-on application of advanced statistical modeling and econometric techniques. The research plan has three aims: Aim 1. To understand the organization of surgical practice in the United States. Using both administrative and survey data, the candidate will determine the proportion of surgical care provided in four distinct organizational settings: 1) integrated delivery systems, 2) multispecialty groups, 3) single- specialty groups, and 4) solo or 2-person practices. He will also explore the relationship between physician organization and potential determinants of efficiency, including financial incentives and use of care coordination strategies. Aim 2. To examine the relationship between physician organization and quality of surgical care. Using national Medicare claims data (2006-2008), the candidate will then compare risk-adjusted operative mortality, rates of readmission, and post-operative complications among patients undergoing common inpatient procedures performed by surgeons working in the same four organizational settings. He posits that surgeons working in integrated delivery systems will have better outcomes, due in part to their greater capacity for information exchange and care coordination. Aim 3. To evaluate the relationship between physician organization and costs of surgical care. Finally, for the same physician organizations, the candidate will compare Medicare expenditures related to the index episode of surgical care. Specific costs to be assessed include (among others) overall hospital payments, payments for physician services, and payments for post-acute care. He hypothesizes that surgeons in single-specialty practices will provide more expensive care based on, among other factors, greater use of consultants, diagnostic tests, and post-discharge ancillary care. Completion of the proposed research will illuminate the potential quality and cost implications of Medicare ACOs and clarify the merits of a voluntary ACO implementation strategy. PUBLIC HEALTH RELEVANCE: This proposal will evaluate the current organization of surgical practice in the United States and its relationship to the quality and cost of surgical care. Our findings will prove immediately relevant to policymakers seeking to better understand both the quality and cost implications of Medicare Accountable Care Organizations (ACO) and the relative merits of a voluntary ACO implementation strategy.

描述（由申请人提供）：围绕医疗保险计划中责任医疗组织 (ACO) 实施的政策辩论将通过更好地理解医生组织与医疗质量和成本之间的关系而得到极大的启发。在这种背景下，候选人（大卫·C·米勒博士）试图评估美国外科手术的组织及其与效率的关系。该候选人是密歇根大学的泌尿科医生和健康服务研究员，他将利用这一提案来扩大其研究议程的科学和临床范围，并促进他发展成为一名独立研究者。在支持期间，他将在多个学科中进行额外的教学指导，包括高级统计和计量经济学方法（例如分层建模）、医疗保健组织和医疗保健政策的博士级课程。他还将有充足的机会进行指导性的、基于项目的学习，包括先进统计模型和计量经济学技术的实际应用。该研究计划有三个目标： 目标 1. 了解美国外科实践的组织。使用管理和调查数据，候选人将确定在四种不同组织环境中提供的外科护理的比例：1）综合交付系统，2）多专业小组，3）单一专业小组，以及4）单人或两人实践。他还将探讨医生组织与效率的潜在决定因素之间的关系，包括经济激励和护理协调策略的使用。目标 2. 检查医师组织与手术护理质量之间的关系。使用国家医疗保险索赔数据（2006-2008），候选人将比较接受由在相同四个组织环境中工作的外科医生进行的常见住院手术的患者的风险调整手术死亡率、再入院率和术后并发症。他认为，在集成输送系统中工作的外科医生将获得更好的结果，部分原因是他们具有更强的信息交换和护理协调能力。目标 3. 评估医生组织与手术护理成本之间的关系。最后，对于相同的医生组织，候选人将比较与外科护理指数事件相关的医疗保险支出。需要评估的具体费用包括（除其他外）总体医院费用、医生服务费用以及急性期后护理费用。他推测，由于更多地使用顾问、诊断测试和出院后辅助护理等因素，单一专业实践的外科医生将提供更昂贵的护理。拟议研究的完成将阐明医疗保险 ACO 的潜在质量和成本影响，并阐明自愿 ACO 实施策略的优点。 公共卫生相关性：该提案将评估美国当前的外科实践组织及其与外科护理质量和成本的关系。我们的研究结果将证明与寻求更好地了解 Medicare 责任医疗组织 (ACO) 的质量和成本影响以及自愿 ACO 实施策略的相对优点的政策制定者直接相关。