Health Care Variation and Its Determinants: Studies on Physician Quality, Cancer Screening, and Cardiovascular Care

Abstract

This dissertation investigates drivers of variation in health care utilization and quality, with a focus on physician decision-making and patient outcomes. The first chapter examines the distribution of new physician quality across the United States, as measured by senior physicians’ evaluations. It explores how physician quality relates to the characteristics of the patient populations and geographic areas that physicians serve. The second chapter investigates how primary care physicians’ exposure to new cancer diagnoses among their patients influences their screening behavior for other patients, using a quasi-experimental study design and all-payer claims data. The third chapter analyzes the continuity and disruption of follow-up cardiovascular care, using electronic health records data and metadata to identify the patient, physician, and system attributes that influence cascades of care and their outcomes. Through insights into key determinants of quality and utilization of health care, this dissertation highlights the need for systems-level interventions to improve the care delivered to all populations.