Measuring the Clinical and Economic Outcomes Associated with Delivery Systems
Our project examines relationships among the organization of health care providers, the delivery of evidence-based care, clinical and economic outcomes, and patient experiences. To this end, we have mapped health systems across the entire United States over many years. We have developed some new performance measures and have calculated new and existing performance measures to study variation in performance across organizational types, health systems, and geographic areas. Finally, we combine data on health care organization and performance to study topics such as the consequences of corporate consolidation and the diffusion of best practices.
Our aims are three-fold:
- Characterize the current delivery system and track changes in delivery system structure across space and over time.
- Gather data on the use of evidence from patient-centered outcomes research (PCOR) and related clinical and economic outcomes and merge those data with delivery system information.
- Use these data sources to examine associations between differences in delivery system structure and use of PCOR-based evidence and related clinical and economic outcomes.
Our research is conducted at both the national and state levels. Analyses measure health system organization and performance at a point in time, changes over time, and across geographic areas. Under this initiative, five research projects are underway to examine delivery system performance in several distinct areas by: looking across a variety of delivery systems (Projects 1 and 2); considering specific populations where evidence-based care involves tailoring care to the needs of the population, such as oncology, children, and post-acute care (Projects 3, 4, and 5); and considering the outcome of corporate integration in a number of settings (Projects 1 and 5).
Project 1 – Delivery System Structure and Outcomes: A National Look – focuses on how economic outcomes are affected by delivery system organization and ownership. We have been working to describe these relationships by characterizing the organization of care and variation in clinical and economic outcomes across patients and groups of providers.
Project 2 – Delivery Systems and Outcomes in Four States – focuses on how care varies within and across four states: Colorado, Massachusetts, Oregon, and Utah. These states have different health systems and All Payer Claims Databases which has facilitated comparisons in care delivery across settings and the tracking of the use of PCOR-based evidence and clinical and economic outcomes over time.
Project 3 – Characteristics of High-Performing Delivery Systems of Cancer Care – focuses on how the organization of oncology care affects the use of PCOR-based processes and related clinical and economic outcomes in adult patients with cancer.
Project 4 – Accelerating the Performance of Pediatric Health Systems – focuses on pediatric features of health system structures and examines the degree to which these features relate to PCOR-based care quality.
Project 5 – Post-Acute Care and Dialysis – focuses on consolidation and organizational change in two understudied health care industries that account for a significant share of total medical spending – post-acute care facilities and dialysis facilities – and examines their impact on the use of PCOR-based evidence, spending, and clinical outcomes.
Critical to conducting the research and achieving the aims described above are the data to describe health care organization and to measure performance, specifically:
- administrative and claims data that can be used to measure the use of PCOR-based evidence, related clinical outcomes data, and costs of care
- patient and family self-reports about the quality of care that they receive
- micro data on health systems, hospitals, physicians, and other (e.g., post-acute care) providers
In this context, a key output of our work has been the creation of a Health Systems and Provider Database (HSPD), which we believe represents a best-in-class source of information on ownership relationships among hospitals, physicians, and other providers in the US, and therefore holds significant promise for the health policy and research community at-large. For more details regarding the HSPD, please visit: Health Systems and Provider Database.
David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University. His research interests include the determinants of health status and longevity, the economics of health care delivery, and health policy.