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Essays on Public Outcomes Reporting and Technology Adoption in Health Care.

机译：关于卫生保健中公共成果报告和技术采用的论文。

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摘要

This dissertation consists of three essays on hospital-based healthcare delivery. The first essay examines the effect of public reporting of hospital-level surgical mortality rates on patient outcomes in the context of California's coronary artery bypass graft (CABG) report cards and the Acute Coronary Syndrome (ACS) population from 2004–2007. Compared to control states, I find that observed mortality rates in California improved by 12–19% after the introduction of report cards with the effect relating to quality improvement in all areas of patient care, including initial care of acute patients, surgery characteristics, and postoperative care.;The second essay examines the diffusion of robotic surgery technology and its effect on patient treatment patterns. The diffusion of this technology has coincided with a rapid period of growth in surgical treatment of prostate cancer, and this has raised questions of whether technology adoption is driving overtreatment. I find that technology adoption accounts for 37–73% of increased age-adjusted surgery rates, and this is substitution away from radiation therapy. However, robotic surgery adoption explains only 12–24% of the increased total surgical volume. I show that, instead, two population trends account for most of the growth in surgery volume.;The third essay examines the relationship between robotic surgery adoption and the market structure of the surgical treatment of prostate cancer. I show strong correlation between hospital robot adoption and increases in market share. Higher diffusion of robotic surgery is associated with exit of small volume providers from this procedure market and growth in the number and size of high volume providers, whose collective market share nearly doubled from 2003 to 2009. This market consolidating effect accelerated the availability of the new treatment to patients and has implications for how strategic competition may drive technology diffusion.
机译：本文由三篇关于医院医疗保健的论文组成。第一篇文章探讨了在2004年至2007年间，加利福尼亚州的冠状动脉搭桥术（CABG）报告卡和急性冠脉综合征（ACS）人群的背景下，公开报告医院级手术死亡率对患者预后的影响。与对照组相比，我发现在引入报告卡后，加利福尼亚州观察到的死亡率提高了12-19％，其效果与患者护理各个领域的质量改善有关，包括急性患者的初始护理，手术特点和第二篇文章探讨了机器人手术技术的普及及其对患者治疗方式的影响。这项技术的普及与前列腺癌外科治疗的快速增长相吻合，这引起了人们对技术采用是否正在推动过度治疗的质疑。我发现，采用技术的人占年龄调整后的手术率上升的37％至73％，这是放射治疗的替代方法。但是，采用机器人手术只能解释增加的总手术量的12–24％。我表明，相反，两种人群趋势占手术量增长的大部分。第三篇文章探讨了机器人手术采用率与前列腺癌手术治疗市场结构之间的关系。我发现医院采用机器人与市场份额增长之间存在很强的相关性。机器人外科手术的普及与小批量医疗服务提供者退出该程序市场以及大批量医疗服务提供者的数量和规模的增长有关，从2003年到2009年，大批量医疗服务提供者的集体市场份额几乎翻了一番。对患者的治疗，对战略竞争如何推动技术扩散具有影响。

著录项

  • 作者

    Wang, Thomas Dean.;

  • 作者单位

    Harvard University.;

  • 授予单位 Harvard University.;
  • 学科 Economics General.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 157 p.
  • 总页数 157
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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