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

Tang, Yan (2015) Health care system, provider and patient predictors of prescribing quality and efficiency. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tang, Yanyat11@pitt.eduYAT11
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue, Julie Mjdonohue@pitt.eduJDONOHUE
Committee MemberLave, Judith Rlave@pitt.eduLAVE
Committee MemberChang, Chung-Chou
Committee MemberGellad, Walid
Date: 29 June 2015
Date Type: Publication
Defense Date: 20 January 2015
Approval Date: 29 June 2015
Submission Date: 23 March 2015
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 120
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Medication, Prescribing quality, Prescribing efficiency, Medicare, Medicaid
Date Deposited: 29 Jun 2015 16:21
Last Modified: 15 Nov 2016 14:26


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