Our portfolio of work examines the impact of a broad range of factors on healthcare spending and quality of care:

Individual-level factors

Part of our research examines how diverse patient characteristics—such as sociodemographic factors and specific diseases–may be associated with differences in quality and spending. A portion of our portfolio is focused on vulnerable populations in the U.S., analyzing disparities in quality of care. We are also interested in high-need, high-cost populations: patients who account for a disproportionate level of healthcare spending and tend to experience worse outcomes. Additionally, we produce studies focused on specific conditions and comorbidities, investigating how the presence of these conditions might influence patient interactions with the healthcare system.

Example papers/projects:

  1. Figueroa JF, Lyon Z, Zhou X, Grabowski DC, Jha AK. Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries: An Observational Study. Ann Intern Med. 2018 Oct 16; 169(8):528-534.
  2. Burke L, Khillar D, Orav EJ, Zheng A, Jha AK. Do Academic Medical Centers Disproportionately Benefit the Sickest Patients? Health Aff. 2018 June; 37(6): 864-872.

Provider-level factors

Our next topic of interest is provider-level factors, aiming to understanding how structures and incentives influence the care provided. We analyze the impact of differing reimbursement structures and alternative payment models, such as pay-for-performance models. We are also interested in whether physician specialty, physician training, or differences in practice volume and size affect patient outcomes and spending.

Example papers/projects:

  1. Tsugawa Y, Jena AB, Orav EJ, Blumenthal DM, Tsai TC, Mehtsun WT, Jha AK. Age and sex of surgeons and mortality of older surgical patients: observational study. BMJ. 2018 April 25; 361: k1343.
  2. Figueroa JF, Tsugawa Y, Zheng J, Orav EJ, Jha AK. The Association Between the Value-Based Purchasing Pay-For-Performance Program and Patient Mortality in U.S. Hospitals. BMJ. 2016 May 9; 353:i2214.

Facility-level factors

At the facility level, our work focuses on understanding the characteristics that differentiate the highest performers from the lower performers. We examine factors such as hospital teaching status, integration of services, and use of health information technology to understand how institutions can best improve care while managing costs.

Example papers/projects:

  1. Lam MB, Figueroa JF, Feyman Y, Reimold KE, Orav EJ, Jha AK. Association between patient outcomes and accreditation in US hospitals: observational study. BMJ. 2018 Oct 18; 363:k4011.
  2. Burke LG, Frakt AB, Khullar D, Orav EJ, Jha AK. Association Between Teaching Status and Mortality in US Hospitals. JAMA 2017 May 23; 317(20): 2105-2113.

Health system-level factors

Policymakers and healthcare leaders have implemented numerous programs and structures aimed at improving value. Our research evaluates the effectiveness of these system-level initiatives, such as the Hospital Quality Alliance Program, the Medicare Shared Savings Program, and the Hospital Readmissions Reduction Program. We also examine the role of public reporting, transparency, and appropriate metrics in improving health system quality. A portion of our work extends beyond the U.S. to compare health systems internationally with the goal of better understanding characteristics of high performers.

Example papers/projects:

  1. Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA 2018 March 13; 319(10): 1024-1039.
  2. Lam MB, Figueroa JF, Zheng J, Orav EJ, Jha AK. Spending Among Patients With Cancer in the First 2 Years of Accountable Care Organization Participation. J Clin Oncol. 2018 Aug 29: JCO1800270. doi: 10.1200/J

External factors

Finally, we seek to analyze the healthcare system impacts of broad, external factors that transcend the healthcare system itself. One portion of our portfolio is focused on climate change and its effects on health, healthcare infrastructure, quality and utilization of care, and costs. We hope that a more comprehensive understanding of the impact of climate change-related events—such as extreme weather and heat—can allow hospitals and healthcare systems to better prepare for this growing threat.

Example papers/projects:

  1. Ongoing: Analysis of healthcare system impacts of extreme weather events, led by Dr. Renee Salas
  2. Salas RN, Laden F, Jacobs WB, Jha AK. The U.S. Environmental Protection Agency’s Proposed Tran sparency Rule Threatens Health. Ann Int Med. 2019 Feb 5; 170(3):197-198.