Associate Professor of Finance Pinar Karaca-Mandic recently received a $1.6 million grant from the Agency for Healthcare Research and Quality (AHRQ). This four-year grant will fund a project to understand the physician, healthcare delivery organization, and market-level factors related to how doctors discontinue using ineffective treatments.
As principal investigator, Karaca-Mandic will work with collaborators from the U of M School of Public Health, Mayo Clinic, Harvard Medical School, and Yale University. “We’ve been bringing this together since the summer of 2014. That’s how long it takes for a research project to get funded,” she said. The goal was a five-year project. The National Institutes of Health liked the idea, but was unable to fully fund the proposal. Instead, it offered Karaca-Mandic a Bridge Award – one year of funding to get the project started. “We were able to get AHRQ for the other four years to do this work,” she said.
A lot is known about how physicians adopt new treatments, but less is understood about how treatment procedures get de-adopted when there’s information that they are ineffective or unsafe. “We don’t think that the de-implementation process is a reverse image of adoption,” Karaca-Mandic said. “There are a lot of other factors – sociological biases, how physicians get their information, and the role of markets, for example.”
The project will rely on analyzing data sets from OptumLabs and the Centers for Medicare and Medicaid Services. “It forces you to think about the methodology and what you can ask from the data,” she says. “What are some possible hypotheses? Do you expect younger physicians to adapt to negative information faster because they may be more up to date with the clinical evidence? We are not too sure.”
It could be that older, more experienced doctors are more apt to be faster responders to negative clinical outcomes. Or, physicians who face more market competition will be faster to update. Health organizations that are part of teaching hospitals and physicians’ own peer networks also may play a role in the rate of adaptation.
Because this is such a complicated network of connections, Karaca-Mandic is not only tying together a team from the Carlson, the School of Public Health, Yale, Harvard, and the Mayo, but she’s working with a variety of subject experts such as economists, cardiologists, internal medicine physicians, statisticians, and organizational behaviorists. “The scale is multidisciplinary and multi-institutional,” she says. “Which is really cool.”