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$20 Million for Health Care Reform Research

by Suzanne Wu and Carl Marziali

USC’s growing community of behavioral economists and other experts on health care reform have received a $20 million boost with the announcement of three research grants, including an $11.4 million award to Jason Doctor of the School of Pharmacy.

The three-year grant from the National Institutes of Health is the largest ever received by the pharmacy school. Doctor, an associate professor trained in psychology and behavioral economics, plans to explore ways to dissuade doctors from prescribing antibiotics unnecessarily.

His research partners include health care economist Dana Goldman, director of the Leonard D. Schaeffer Center for Health Policy and Economics at USC, where Doctor holds a joint appointment, and Joel Hay, professor of pharmaceutical economics and policy at the School of Pharmacy, also with a joint appointment at the Schaeffer Center.

The Schaeffer Center, a partnership between the USC School of Pharmacy and the School of Policy, Planning, and Development, figures in two other grants.

Goldman is the lead researcher on a $5.5 million grant to advance the science of Medicare reform. The grant is funded under a high-profile program addressing top priorities of National Institutes of Health director Francis Collins.

Hay serves on a team led by Shinyi Wu, assistant professor in the Epstein Department of Industrial and Systems Engineering at the USC Viterbi School of Engineering, which will study ways to improve outcomes for the many diabetic patients who become depressed. Goldman served in an advisory role during the proposal process, which ended with a $3 million grant from the Department of Health and Human Services. Kathleen Ell of the USC School of Social Work is Wu’s co-principal investigator, with support from Chih-Ping Chow of the Keck School of Medicine of USC and Shri Narayanan of USC Viterbi.

“Health reform demands a careful assessment of the economics and effectiveness of care delivery to reduce cost, increase access and improve health,” said Randolph Hall, vice president of research at USC. “This will become increasingly important over time due to aging population and changes in workforce demographics.”

Steven Moldin, executive director of the Office of Research Advancement, called the grant to Doctor “part of USC’s larger program on health care economics established at the Leonard D. Schaeffer Center under Dana Goldman’s vision. USC has established world-class leadership in health care economics and policy analysis.”

Moldin’s office was involved in identifying the grant opportunities, assembling the scientific teams and preparing the grant proposals.

The grant to Doctor’s group aims to improve prescription practices for common acute respiratory infections, which include bronchitis and influenza. Aggressive antibiotic prescribing is a major public health concern for its suspected link to the spread of antibiotic-resistant bacteria.

“It’s widely agreed among physicians that antibiotics are overprescribed, but if you ask a physician about their own care of patients, they tend to see less of a problem,” Doctor said.

“Decisions can be affected by how the clinical environment is structured. If we can modify that structure while preserving physician choice, we may be able to improve prescribing decisions without forcing providers to abide by a particular rule.”

Doctor and his team will apply behavioral economics – the science of how people make decisions – to help reduce the frequency with which doctors prescribe antibiotics for certain acute respiratory infections.

Strategies might include designating nonantibiotic treatments as the default option for certain diagnoses within electronic prescribing systems and providing information to physicians about their rate of antibiotic prescription compared to that of their best-performing peers.

“Fewer resistant strains means fewer people dying,” Doctor said.

R. Pete Vanderveen, dean of the USC School of Pharmacy, said: “Jason Doctor is an exceptional scientist who is conducting important research to address the serious national health issue of over-prescribing of antibiotics for respiratory infections. This project holds great promise for not only improving patient care but reducing health care costs – a critical national priority.”

Moldin added, “A unique component in Jason Doctor’s project is inclusion of underserved populations through our partnership with community clinics.”

To make sure that strategies are tested in a variety of settings, the grant provides for collaboration with clinics in poorer districts of Los Angeles as well as in more affluent areas near clinics run by Harvard University, the University of Chicago and Northwestern University.

Other investigators include Annie Wong-Beringer, associate professor at the USC School of Pharmacy; behavioral scientists Craig Fox and Noah Goldstein at the UCLA Anderson School of Management; and Daniella Meeker, John Adams and Emmett Keeler from RAND Corp.

The grant is part of a $1.1 billion commitment for comparative effectiveness research in health care and policy. Comparative effectiveness research, also called evidence-based health care, evaluates how various drugs, treatments and services stack up against one another in efficacy and cost.

All three grants were made possible by the American Recovery and Reinvestment Act of 2009.

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$20 Million for Health Care Reform Research

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