HSR&D Research Career Scientist Award Application

Veterans Admin Palo Alto Health Care Sys, Palo Alto CA

Investigators

Abstract

Dr. Wagner is a highly productive VA health economist who is tackling high-impact and persistent problems in the VA health care system for which health services research might provide meaningful insights and solutions. Dr. Wagner directs the Health Economics Resource Center (HERC) and is the Associate Director of the Palo Alto Center of Innovation, known as the Center for Innovation to Implementation (Ci2i). He devotes 8/8ths of his time to research related activities, which includes research, mentoring, and service. Dr. Wagner's scholarship places him among the top health economists in the nation. He has authored over 150 papers and chapters, 122 of which were peer-reviewed. His research has been published top journals including New England Journal of Medicine, JAMA, Journal of Health Economics, and Health Services Research. He is frequently sought out by junior and senior researchers, who value his insights, expertise and perspective. Dr. Wagner has been affiliated with Stanford University since 1999. Starting in November 2016, Dr. Wagner was appointed as an Associate Professor of Research in the Department of Surgery at Stanford University. Dr. Wagner's RCS research plan focuses on three interrelated themes: health information, value and efficiency, and access. During the RCS, Dr. Wagner will write three proposals. The first proposal seeks to understand clinician behavior in response to new information about high value care. Cost-effectiveness analyses often fail to change clinician behavior and we need to understand why if we want to change behavior and improve patients' outcomes by redirecting the up to 30% of spending that is deemed of little or no value. The second proposal seeks to develop new performance metrics that identify which VA medical centers are providing high value care. Currently, performance metrics focus on either process quality indicators (e.g., hospital acquired infection) or on resource use (e.g., readmission or length of stay). There are no performance metrics that consider both quality and costs. Such metrics will be necessary to ensure that facilities are simultaneously trying to improve patient outcomes while wisely managing their resources. Finally, the third proposal will focus on access to care and whether the large growth in telemedicine is acting as a substitute or as a complement for face to face care. Understanding this distinction is critical if the VA is seeking to improve access within a limited budget. The three aims are integrated in their focus to identify high value care and then create incentives that reward the delivery of high value care. Dr. Wagner's RCS award also outlines ambitious plans for service and training. In particular, Dr. Wagner is developing and pilot testing a “data bootcamp” curriculum. The two-day bootcamp is designed to orient VA and Stanford researchers to VA data opportunities and potential methods for answering research questions. The RCS will enable Dr. Wagner to finalize this curriculum and then work with VIReC to disseminate the curriculum more broadly.