Informal Physician Networks and Patterns of Care for Medicare Beneficiaries

非正式医生网络和医疗保险受益人的护理模式

• 批准号: 7797990
• 负责人: Bruce E. Landon
• 金额: $ 17.19万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7797990
• 关键词: Address; Affect; Age; Area; Behavior; Caring; Characteristics; Clinical; Complex; Cost Control; Data; Data Set; Decision Making; Diffusion; Educational process of instructing; Enrollment; Environment; Exhibits; Geographic Locations; Graph; Health; Health Planning; Health Services; Healthcare; Hospice Care; Hospital Referrals; Hospitals; Individual; Intervention; Light; Link; Literature; Managed Care; Marketing; Measures; Medical; Medicare; Methods; Neighborhoods; Ownership; Pathway Analysis; Patient Care; Patient Preferences; Patients; Pattern; Patterns of Care; Physician' s Practice Patterns; Physicians; Play; Policies; Positioning Attribute; Poverty; Primary Care Physician; Primary Health Care; Principal Investigator; Program Research Project Grants; Property; Provider; Research Personnel; Resources; Role; Rural; Services; Shapes; Social Network; Specialist; Structure; System; Urban Population; Variant; Work; beneficiary; cohesion; cohort; cost; end of life; experience; financial incentive; health care delivery; health care service utilization; hospice environment; improved; insight; interest; novel; patient population; preference; programs; sex; statistics

Physicians, both directly through services they provide and indirectly through the services that they order, shape the vast majority of health care utilization in the U.S. There has long been interest in the determinants of physician decision-making because optimizing physician decisions has the potential to improve the quality of U.S. health care while also controlling costs by eliminating the use of unnecessary services. One influence on physician decision-making that has largely been ignored, however, has been physicians' position in the larger networks of doctors. In this setting, "networks" refer to informal networks of primary care and specialist physicians who share patients and information rather than to formal networks of all of the physicians formally affiliated with a health plan or hospital. In practice, each physician, particularly each primary care physician, develops distinct sets of specialist physicians with whom they share patients and information. By virtue of sharing patients, these networks can be defined empirically. These networks of physicians in turn have the potential to influence an individual physician's decision making, and such influences may vary depending on the structure of the network and/or occurrences within the network. In this project, we aim to improve our understanding of this phenomenon. We also aim to explore the contribution of network properties to observed variations in spending and treatment patterns within the Medicare program. Our proposal has the following specific aims: (1) to create and describe a dataset about physician networks using comprehensive national data from the Medicare program regarding over 10 million people and up to 150,000 doctors; (2) to identify the characteristics of different types of hospitals and regional hospital markets that are associated with physician networks and to examine the extent to which formal organizations influence the formation of informal networks; (3) to examine the characteristics of individual primary care and specialist physicians that are associated with properties of physician-centered and geographically delimited physician networks; and (4) to evaluate the contribution of physician networks to variations in health spending and the use of particular health care services (e.g., hospice care) according to geographic regions. The role of networks and the extent to which network connections influence the clinical decisions made by individual physicians is unknown. A better understanding of this complex phenomenon will improve our ability to influence physician decision making to improve quality and decrease costs and provide novel insights into the role that provider connections play in the delivery of health care.

直接通过他们提供的服务并间接通过他们订购的服务，医生， 塑造美国绝大多数医疗保健利用率，长期以来一直对决定因素感兴趣 医师的决策，因为优化医师的决策有可能提高质量 美国医疗保健的同时也通过消除不必要的服务来控制成本。一 然而，对医师决策的影响很大程度上被忽略了 在较大的医生网络中的位置。在这种情况下，“网络”是指主基本网络 关怀和专业医生，他们共享患者和信息，而不是与所有的正式网络 医师正式隶属于健康计划或医院。实际上，每个医生，尤其是每个医生 初级保健医师，开发了与他们共享患者和 信息。通过共享患者，可以从经验上定义这些网络。这些网络 医师反过来有可能影响个别医师的决策，这种情况 影响可能会根据网络的结构和/或网络中的发生而有所不同。在 这个项目，我们旨在提高我们对这一现象的理解。我们还旨在探索 网络特性对观察到的支出和治疗方式的变化的贡献 Medicare计划。我们的建议具有以下具体目的：（1）创建和描述有关的数据集 医师网络使用Medicare计划中的全面国家数据，涉及超过1000万 人和多达15万名医生； （2）确定不同类型医院的特征和 与医师网络相关的区域医院市场并检查 正式组织影响非正式网络的形成； （3）检查 与以医师为中心的特性相关的个人初级保健和专业医师 和地理界定的医师网络； （4）评估医师网络的贡献 根据健康支出和特定医疗保健服务的使用（例如临终关怀医疗）的变化 到地理区域。网络的作用以及网络连接影响的程度 个人医生做出的临床决定尚不清楚。更好地理解这个复杂的 现象将提高我们影响医师决策以提高质量和降低的能力 成本并提供有关提供者联系在提供医疗保健中的作用的新颖见解。