Essays on Public Outcomes Reporting and Technology Adoption in Health Care

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Essays on Public Outcomes Reporting and Technology Adoption in Health Care

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Title: Essays on Public Outcomes Reporting and Technology Adoption in Health Care
Author: Wang, Thomas Dean
Citation: Wang, Thomas Dean. 2012. Essays on Public Outcomes Reporting and Technology Adoption in Health Care. Doctoral dissertation, Harvard University.
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Abstract: This dissertation consists of three essays on hospital-based healthcare delivery. The first essay examines the effect of public reporting of hospital-level surgical mortality rates on patient outcomes in the context of California’s coronary artery bypass graft (CABG) report cards and the Acute Coronary Syndrome (ACS) population from 2004-2007. Compared to control states, I find that observed mortality rates in California improved by 12-19% after the introduction of report cards with the effect relating to quality improvement in all areas of patient care, including initial care of acute patients, surgery characteristics, and postoperative care. The second essay examines the diffusion of robotic surgery technology and its effect on patient treatment patterns. The diffusion of this technology has coincided with a rapid period of growth in surgical treatment of prostate cancer, and this has raised questions of whether technology adoption is driving overtreatment. I find that technology adoption accounts for 37-73% of increased age-adjusted surgery rates, and this is substitution away from radiation therapy. However, robotic surgery adoption explains only 12-24% of the increased total surgical volume. I show that, instead, two population trends account for most of the growth in surgery volume. The third essay examines the relationship between robotic surgery adoption and the market structure of the surgical treatment of prostate cancer. I show strong correlation between hospital robot adoption and increases in market share. Higher diffusion of robotic surgery is associated with exit of small volume providers from this procedure market and growth in the number and size of high volume providers, whose collective market share nearly doubled from 2003 to 2009. This market consolidating effect accelerated the availability of the new treatment to patients and has implications for how strategic competition may drive technology diffusion.
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:10288424
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