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以更少投入实现更多成效:预测初级保健提供者的有效性

Doing More with Less: Predicting Primary Care Provider Effectiveness
Review of Economics and Statistics · 2023 · Janet Currie、Jonathan Zhang

中文摘要

我们利用退伍军人事务部的数据,考察初级保健提供者(PCP)的有效性。借助退伍军人被准随机分配给 PCP 这一机制,我们通过可避免住院疾病(ACSC)以及因精神健康或循环系统疾病导致的住院/急诊科(ED)就诊来衡量有效性。PCP 在这些维度上的差异可预测未来结果。例如,精神健康有效性提高一个标准差,可使患者在未来三年内的死亡风险降低 3.8%,成本降低 4.4%。更有效的 PCP 能以更少投入实现更多成效:其患者的初级保健就诊、专科转诊、实验室组合检查或影像学检查均更少。

Abstract

We use data from the Veterans Administration to examine the efficacy of primary care providers (PCPs). Leveraging quasi-random assignment of veterans to PCPs, we measure effectiveness using ambulatory care sensitive conditions (ACSC) and hospitalizations/emergency department (ED) visits for mental health or circulatory conditions. PCPs variation along these dimensions predicts future outcomes. For example, a one standard deviation improvement in mental health effectiveness reduces patient risk of death by 3.8% and lowers costs by 4.4% over the next three years. More effective PCPs do more with less: their patients have fewer primary care visits, specialist referrals, lab panels, or imaging tests.
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