Essays on health economics and technology adoption

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2011.Cataloged from PDF version of thesis.Includes bibliographical references.This thesis studies the economics of technology adoption in the healthcare industry. The first chapter analyzes the impact of health information technology (HIT) on the quality and intensity of care delivered to Medicare inpatients. Building an organizational model, I show how the adoption of HIT may improve patient health and may either increase or decrease medical expenditures. Using Medicare claims data from 1998-2005, I estimate the effects of HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with an initial 1.3% increase in billed charges. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, medical complication rates, adverse drug events, and readmission rates. These results are robust to the addition of rich controls for pre-trends. The findings suggest that HIT is not associated with improvements in either the efficiency or quality of hospital care for Medicare patients, through five years after adoption. In the second chapter, I investigate the scope for physician learning about the value and applications of new medical technologies across geographic regions. In particular, I analyze the diffusion of positron emission tomography and deep brain stimulation, using data on Medicare claims from 1998-2005. The mix of patient diagnoses treated with the new technologies changes substantially during the early stages of diffusion. Moreover, states that are late to adopt these technologies do not repeat the process of experimental learning undertaken by early adopters to discover which patients should receive the new treatment In the third chapter, I analyze several policy initiatives that aim to manage the usage of medical technologies and discuss key determinants of technology adoption that may be fruitful targets for future research and policy intervention. Effective technology policy must balance cost, control with a recognition that new medical technologies have been associated with tremendous health and longevity gains. I find that existing Medicare coverage determinations and state certificate of need programs appear to have little influence on actual resource utilization, in part driven by lack of enforcement of existing policies.by Leila Agha.Ph.D

Effect of touch therapy by mothers on weight gaining of preterm newborns

Introduction: The effect of touch on growth of newborns has been achieved by educated staff, but touch therapy by mothers as the most important care provider for their infants, had not been focused in previous studies. The aim of this work was to study effect of touch therapy by mothers on weight gaining of preterm newborns. Materials and Methods: In a randomized controlled trail and double blind study, 60 preterm newborns who discharged from neonatal intensive care unit (NICU) to home, randomly allocated to control and touch therapy group (30 newborns in each group). Touch therapy was educated to mother in a direct education, also with offering guide booklet to the mothers. Touch was provided for three 20 minute period per day, until term corrected age. Neonate weight in two groups was measured at the time of discharge and then at the term corrected age by the electronic weighing scale with an accuracy of ± 10 gr. Results: In two groups, mean of age, kind of delivery, level of education, employment and socioeconomic status in mothers, also weight, sex and other neonate characteristics had no statistical differences. At the term corrected age, interventional group showed a weight gain of 10 g/day (30) more than control, which was statistically significant (31 g/day vs 21 g/day) (P=0.04). Conclusion: An important aspect of this study is that all stimulations were provided by mothers which had positive impact for preterm newborns, So, education of touch therapy to mothers can be recommended before discharge of pre-term newborns

The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care

A large body of research has investigated whether physicians overuse care. There is less evidence on whether, for a fixed level of spending, doctors allocate resources to patients with the highest expected returns. We assess both sources of inefficiency exploiting variation in rates of negative imaging tests for pulmonary embolism. We document enormous across-doctor heterogeneity in testing conditional on patient population, which explains the negative relationship between physicians’ testing rates and test yields. Furthermore, doctors do not target testing to the highest risk patients, reducing test yields by one third. Our calibration suggests misallocation is more costly than overuse

The Effect of Educational Intervention based on Social Support Theory on Improvement of Hemodialysis Patients’ Quality of Life

Chronic kidney failure is a progressive and irreversible degeneration of renal function that affects the quality of life of patients. Social support as a coping mechanism can help promote health and improve the quality of life of a person. The purpose of this study was to determine the effect of educational intervention based on social support theory on the improvement of hemodialysis patients’ QOL. This is a controlled quasi-experimental conducted in 2015 in Sari and with the participation of 100 hemodialysis patients that were randomly assigned to 2 groups. Prior to education, the patients were evaluated with demographic form, quality of life (WHOQOL-BREF) and social support (MOS-SSS) questionnaires. Then, an educational program was developed based on social support theory and implemented for the intervention group. The two groups were re-evaluated with the same questionnaires after 1 and 3 months and the data were analyzed in SPSS. In the intervention group compared to the control group, the mean scores of quality of life and social support increased significantly after the intervention (

Treatment of oral lichen planus with photodynamic therapy mediated methylene blue : A case report

Oral lichen planus (OLP) is a common chronic disease of uncertain origin. Many patients with OLP are refractory to all available therapies. The photodynamic therapy (PDT) was used as a possible alternative method in the treatment of lichen planus. Two patients with five oral lichen planus lesions were treated using topical PDT mediated by methylene blue (MB-PDT). The patients were followed up on sessions 3, 7, 15 days and 1 to 9 months after PDT. Clinical improvement was achieved in four lesions. Two lesions showed complete remission, and another two lesions had about 50% clinically improvement 3-9 months after a single session of PDT. No response detected in one lesion. MB-PDT blue seems to be an effective alternative treatment for control of OLP. In our opinion, this preliminary result warrant further studies in order to show the efficacy of MB-PDT in control of OLP for a longer period of time

The exact synchronization timing between the cleavage embryo stage and duration of progesterone therapy-improved pregnancy rates in frozen embryo transfer cycles: A cross-sectional study

Background: Synchronization between the embryonic stage and the uterine endometrial lining is important in the outcomes of the vitrified-warmed embryo transfer (ET) cycles. Objective: The aim was to investigate the effect of the exact synchronization between the cleavage stage of embryos and the duration of progesterone administration on the improvement of clinical outcomes in frozen embryo transfer (FET) cycles. Materials and Methods: 312 FET cycles were categorized into two groups: (A) day- 3 ET after three days of progesterone administration (n = 177) and (B) day-2 or -4 ET after three days of progesterone administration (n = 135). Group B was further divided into two subgroups: B1: day-2 ET cycles, that the stage of embryos were less than the administrated progesterone and B2: day-4 ET cycles, that the stage of embryos were more than the administrated progesterone. The clinical outcome measures were compared between the groups. Results: The pregnancy outcomes between groups A and B showed a significant differences in the chemical (40.1% vs 27.4%; p = 0.010) and clinical pregnancies (32.8% vs 22.2%; p = 0.040), respectively. The rate of miscarriage tended to be higher and live birth rate tended to be lower in group B than in group A. Also, significantly higher rates were noted in chemical pregnancy, clinical pregnancy, and live birth in group A when compared with subgroup B2. Conclusion: Higher rates of pregnancy and live birth were achieved in day-3 ET after three days of progesterone administration in FET cycles. Key words: Endometrium, Embryo transfer, Pregnancy, Live birth, Progesterone

Team formation and performance: evidence from healthcare referral networks

We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals — for instance, sending their cardiology patients to fewer distinct cardiologists — this encourages repeat interactions between PCPs and specialists. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with 1 standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims, and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.P01 AG005842 - NIA NIH HHSPublished versio

Integration of standardization and customization: impact on service quality, customer satisfaction, and loyalty

The basic objective of this study is to analyse the direct and indirect impacts of standardization and customization on customer satisfaction and loyalty through service quality. The service quality has two dimensions: technical quality and functional quality. A framework is developed by extending Grӧnroos’ model of service quality by including the antecedents of service quality. A questionnaire-based survey collected data from 315 customers of three service industries: healthcare, hospitality, and education. The data was analysed and the model validated using PLS-SEM. The findings show that: (1) integration of standardization and customization of service offerings is critical for improved service quality; (2) standardization has higher impact on service quality when compared to customization; (3) functional quality has higher impact on customer satisfaction when compared to technical quality; and (4) customer satisfaction has a significant effect on customer loyalty. The contribution of this study is the development of an integrated framework to analyse the roles of standardization and customization on service quality

Call for emergency action to restore dietary diversity and protect global food systems in times of COVID-19 and beyond: Results from a cross-sectional study in 38 countries

Background: The COVID-19 pandemic has revealed the fragility of the global food system, sending shockwaves across countries\u27 societies and economy. This has presented formidable challenges to sustaining a healthy and resilient lifestyle. The objective of this study is to examine the food consumption patterns and assess diet diversity indicators, primarily focusing on the food consumption score (FCS), among households in 38 countries both before and during the first wave of the COVID-19 pandemic. Methods: A cross-sectional study with 37 207 participants (mean age: 36.70 ± 14.79, with 77 % women) was conducted in 38 countries through an online survey administered between April and June 2020. The study utilized a pre-tested food frequency questionnaire to explore food consumption patterns both before and during the COVID-19 periods. Additionally, the study computed Food Consumption Score (FCS) as a proxy indicator for assessing the dietary diversity of households. Findings: This quantification of global, regional and national dietary diversity across 38 countries showed an increment in the consumption of all food groups but a drop in the intake of vegetables and in the dietary diversity. The household\u27s food consumption scores indicating dietary diversity varied across regions. It decreased in the Middle East and North Africa (MENA) countries, including Lebanon (p \u3c 0.001) and increased in the Gulf Cooperation Council countries including Bahrain (p = 0.003), Egypt (p \u3c 0.001) and United Arab Emirates (p = 0.013). A decline in the household\u27s dietary diversity was observed in Australia (p \u3c 0.001), in South Africa including Uganda (p \u3c 0.001), in Europe including Belgium (p \u3c 0.001), Denmark (p = 0.002), Finland (p \u3c 0.001) and Netherland (p = 0.027) and in South America including Ecuador (p \u3c 0.001), Brazil (p \u3c 0.001), Mexico (p \u3c 0.0001) and Peru (p \u3c 0.001). Middle and older ages [OR = 1.2; 95 % CI = [1.125–1.426] [OR = 2.5; 95 % CI = [1.951–3.064], being a woman [OR = 1.2; 95 % CI = [1.117–1.367], having a high education (p \u3c 0.001), and showing amelioration in food-related behaviors [OR = 1.4; 95 % CI = [1.292–1.709] were all linked to having a higher dietary diversity. Conclusion: The minor to moderate changes in food consumption patterns observed across the 38 countries within relatively short time frames could become lasting, leading to a significant and prolonged reduction in dietary diversity, as demonstrated by our findings