Health care system, provider and patient predictors of prescribing quality and efficiency

摘要: Understanding factors influencing medication utilization and provider prescribing behavior has important implications for the quality improvement cost containment in health care. This dissertation seeks to shed light on efficiency of prescribing. Chapter one examines association between Medicare Part D plan features choice generic antidepressants, antidiabetics, statins using claims data. Low cost-sharing generics, large differentials vs. brand drugs, tools such as prior authorization step therapy are associated with higher drug use. Modifying benefit design management prescription plans might increase use, which could generate substantial savings program beneficiaries. two physician antipsychotic a Medicaid program. By linking multiple data sources membership modeling approach, we examine degree psychiatrists diversified concentrated their identify concentration Antipsychotic is relatively varies substantially across regularly antipsychotics. Several characteristics treated patient population physicians significantly The few organizations examined have little influence over psychiatrist behavior. three assesses provider-level clozapine polypharmacy practices – strong evidence base other support. Using years’ program, find underuse use non-evidence supported practice non-clozapine polypharmacy. However, these vary tremendously providers. In particular, sizable portion providers more than patients. Quality initiatives may take actions improve evidence-based decrease unsupported public because appropriate can alleviate tremendous economic burdens while inappropriate costs risk undesirable consequences. how make decisions points potential opportunities improving care reducing through altering providers’