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Frimpong JA, Guerrero EG, Kong Y, Khachikian T, Wang S, D'Aunno T, Howard DL. Predicting and responding to change: Perceived environmental uncertainty among substance use disorder treatment programs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208947. [PMID: 36880916 DOI: 10.1016/j.josat.2022.208947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) treatment programs offering addiction health services (AHS) must be prepared to adapt to change in their operating environment. These environmental uncertainties may have implications for service delivery, and ultimately patient outcomes. To adapt to a multitude of environmental uncertainties, treatment programs must be prepared to predict and respond to change. Yet, research on treatment programs preparedness for change is sparse. We examined reported difficulties in predicting and responding to changes in the AHS system, and factors associated with these outcomes. METHODS Cross-sectional surveys of SUD treatment programs in the United States in 2014 and 2017. We used linear and ordered logistic regression to examine associations between key independent variables (e.g., program, staff, and client characteristics) and four outcomes, (1) reported difficulties in predicting change, (2) predicting effect of change on organization, (3) responding to change, and (4) predicting changes to make to respond to environmental uncertainties. Data were collected through telephone surveys. RESULTS The proportion of SUD treatment programs reporting difficulty predicting and responding to changes in the AHS system decreased from 2014 to 2017. However, a considerable proportion still reported difficulty in 2017. We identified that different organizational characteristics are associated with their reported ability to predict or respond to environmental uncertainty. Findings show that predicting change is significantly associated with program characteristics only, while predicting effect of change on organizations is associated with program and staff characteristics. Deciding how to respond to change is associated with program, staff, and client characteristics, while predicting changes to make to respond is associated with staff characteristics only. CONCLUSIONS Although treatment programs reported decreased difficulty predicting and responding to changes, our findings identify program characteristics and attributes that could better position programs with the foresight to more effectively predict and respond to uncertainties. Given resource constraints at multiple levels in treatment programs, this knowledge might help identify and optimize aspects of programs to intervene upon to enhance their adaptability to change. These efforts may positively influences processes or care delivery, and ultimately translate into improvements in patient outcomes.
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Affiliation(s)
| | - Erick G Guerrero
- Research to End Healthcare Disparities Corp., United States of America
| | - Yinfei Kong
- California State University, Fullerton, United States of America.
| | | | - Suojin Wang
- Texas A&M University, United States of America.
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Ghandour Z, Siciliani L, Straume OR. Investment and quality competition in healthcare markets. JOURNAL OF HEALTH ECONOMICS 2022; 82:102588. [PMID: 35065851 DOI: 10.1016/j.jhealeco.2022.102588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
We study the strategic relationship between hospital investment and provision of service quality. We use a spatial competition framework and allow investment and quality to be complements or substitutes in patient benefit and provider cost. We assume that each hospital commits to a certain investment before deciding on service quality, and that investment is observable and contractible while quality is observable but not contractible. We show that, under a fixed DRG-pricing system, providers' lack of ability to commit to quality leads to under- or overinvestment, relative to the first-best solution. Underinvestment arises when the price-cost margin is positive, and quality and investments are strategic complements, which has implications for optimal contracting. Differently from the simultaneous-move case, the regulator must complement the payment with one more instrument to address under/overinvestment. We also analyse the welfare effects of different policy options (separate payment for investment, higher per-treatment prices, or DRG-refinement policies).
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Affiliation(s)
- Ziad Ghandour
- Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK.
| | - Odd Rune Straume
- Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Department of Economics, University of Bergen Norway.
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Robinson JC, Jarrion Q. Competition From Biosimilars Drives Price Reductions For Biologics In The French Single-Payer Health System. Health Aff (Millwood) 2021; 40:1190-1197. [PMID: 34339240 DOI: 10.1377/hlthaff.2021.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
France has a single-payer health insurance system that has the authority to impose pharmaceutical price reductions but relies on decentralized market negotiations between hospitals and manufacturers to establish prices for injected and infused biologics. Hospitals rely on biosimilars-less expensive but therapeutically equivalent variants of biologic medications-to stimulate competition. Price reductions negotiated by hospitals subsequently are adopted by the health insurance system, driving hospitals to negotiate a new round of discounts. This article measures 2004-20 trends in prices, price reductions, utilization, and market shares for three prominent biologics-Remicade, Enbrel, and Humira-and their eleven competing biosimilars. Biosimilar launches are associated with a sequence of price reductions for the reference biologic, for other biologics that treat similar conditions, and for all related biosimilars. The French experience provides lessons for the US in its efforts to use competition from biosimilars to drive price reductions and savings from biologics.
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Affiliation(s)
- James C Robinson
- James C. Robinson is the Leonard D. Schaeffer Professor of Health Economics in the Division of Health Policy and Management, School of Public Health, at the University of California Berkeley, in Berkeley, California. He is a Health Affairs contributing editor
| | - Quentin Jarrion
- Quentin Jarrion is a research physician, Health Information Management Department, University Hospitals of Reims, in Reims, France. At the time this research was initiated, he was a visiting scholar at the University of California Berkeley
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Abstract
PURPOSE To empirically verify whether patient hospital satisfaction ratings on social media such as Yelp provide similar information as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. DESIGN/METHODOLOGY/APPROACH OLS and ordinal regressions performed on secondary data obtained from Yelp.com and 2016 Hospital Compare database disclosed by CMS. FINDINGS Results show that the patient hospital satisfaction ratings from Yelp can predict the patient experience of care domain scores obtained through the annual HCAHPS surveys and are also positively and significantly correlated to the overall hospital quality performance scores given by CMS. RESEARCH LIMITATIONS/IMPLICATIONS Study suggests that social media patient review information could be used to supplement the information obtained from HCAHPS surveys, thereby providing hospitals more accurate information about their patient experiences. PRACTICAL IMPLICATIONS Hospital leaders need not wait an entire year to receive their HCHAPS scores to know about the issues related to their patient experience that need improvement and can periodically refer to free Yelp patient review scores on Yelp.com to obtain similar information. ORIGINALITY/VALUE To the best of knowledge, this research is the first to empirically demonstrate that patient reviews freely obtained from social media sites like Yelp can provide similar information as obtained from HCAHPS surveys and can thus be used to supplement HCAHPS.
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Affiliation(s)
- Subhajit Chakraborty
- Department of Management and Decision Sciences, Coastal Carolina University, Conway, South Carolina, USA
| | - E Mitchell Church
- Department of Management and Decision Sciences, Coastal Carolina University, Conway, South Carolina, USA
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Manz CR, Bekelman JE, Doshi JA. The Changing Characteristics of Technologies Covered by Medicare's New Technology Add-on Payment Program. JAMA Netw Open 2020; 3:e2012569. [PMID: 32852550 PMCID: PMC7453306 DOI: 10.1001/jamanetworkopen.2020.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This economic evaluation explores how Medicare’s new technology add-on payment program (NTAP), which provides reimbursement for newly available drugs and devices, has changed during its lifetime since its initiation in 2013.
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Affiliation(s)
- Christopher R. Manz
- Department of Medicine, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia
| | - Justin E. Bekelman
- Departments of Radiation Oncology and Medical Ethics and Health Policy, University of Pennsylvania
| | - Jalpa A. Doshi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
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Regenerative Medicine and Cell Therapy in Orthopedics—Health Policy, Regulatory and Clinical Development, and Market Access. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ex P, Henschke C. Changing payment instruments and the utilisation of new medical technologies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1029-1039. [PMID: 31144069 DOI: 10.1007/s10198-019-01056-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
This paper empirically investigates the impact of additional reimbursement instruments on the diffusion of new technologies in inpatient care. Using 2010-2014 German panel data on hospital level for every patient undergoing coronary angioplasty, this study examines the utilisation of drug-eluting balloon catheters (DEB) over time while additional payment instruments changed. Hypothesising that the utilisation of DEB increased abruptly when a new reimbursement instrument came into force, we estimate a fixed effects regression comparing years with a change and years where the reimbursement instrument remained the same. The model is adjusted for patient age and severity of the disease. The utilisation of DEB increased from 8407 in 2010 to 19,065 in 2014. Hospitals used significantly more DEB when an additional payment instrument changed compared to years when it remained the same. The increase was roughly twice as large. In short, hospitals are incentivised to utilise new technologies if the reimbursement changes to an instrument that is designed in a more reliable way, e.g. including less bureaucracy or guaranteeing fixed prices.
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Affiliation(s)
- Patricia Ex
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, H80, 10623, Berlin, Germany.
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, H80, 10623, Berlin, Germany
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Judson TJ, Dhruva SS, Redberg RF. Evaluation of technologies approved for supplemental payments in the United States. BMJ 2019; 365:l2190. [PMID: 31209124 PMCID: PMC6890455 DOI: 10.1136/bmj.l2190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Timothy J Judson
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
- San Francisco VA Medical Center, Section of Cardiology, San Francisco, CA 94121, USA
| | - Rita F Redberg
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
- Division of Cardiology, University of California, San Francisco, USA
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Faulkner E, Spinner DS, Ringo M, Carroll M. Are Global Health Systems Ready for Transformative Therapies? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:627-641. [PMID: 31198179 DOI: 10.1016/j.jval.2019.04.1911] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND We have seen significant advancement in a range of health technologies, some with transformative or curative potential. Nevertheless, it is often unclear how global health systems recognize or reward innovation. OBJECTIVES To consider what is transformative, challenges for transformative therapies, and downstream health ecosystem effects. METHODS A systematic review of publications in English between 2012 and 2018 was conducted with a focus on value assessment processes and health system effects of a range of breakthrough health technology categories. After screening 9012 records, 222 unique studies were identified. The study also included an analysis of 100 health technology assessments (HTAs) from 5 markets to consider how and in what ways global HTA bodies evaluate transformative therapies. Global sales and technology/procedure utilization data were also evaluated to gain insights into patient access and commercial impact. RESULTS This article evaluated uncertainties around evidence of efficacy, safety, and duration of effect, as well as underlying study quality and methodological considerations in the target categories. Although many HTA evaluations had similar approaches to assessing parameters such as safety, there were significant differences across technology categories. Technology-driven trends also surfaced where global HTA and payer systems may not yet be prepared to recognize and reward emerging technology impacts, including use of next-generation diagnostic results to guide care, considering novel impacts on therapy sequencing and clinical pathway management, and changes in payment and health delivery models. CONCLUSIONS Some trends stemming from rapid evolution of breakthrough therapies will prompt reconsideration of our conventional value assessment and reward models, because health system measurement and management processes have not fully anticipated their effects.
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Affiliation(s)
- Eric Faulkner
- Precision and Transformative Medicine Center of Excellence, Evidera, Durham, NC, USA; Genomics Biotech and Emerging Medical Technology Institute, National Association of Managed Care Physicians, Glen Allen, VA, USA; Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daryl S Spinner
- Precision and Transformative Medicine Center of Excellence, Evidera, Durham, NC, USA
| | - Moira Ringo
- Precision and Transformative Medicine Center of Excellence, Evidera, Durham, NC, USA
| | - Marissa Carroll
- Precision and Transformative Medicine Center of Excellence, Evidera, Durham, NC, USA
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Robinson JC. Value-Based Physician Payment in Oncology: Public and Private Insurer Initiatives. Milbank Q 2018; 95:184-203. [PMID: 28266072 DOI: 10.1111/1468-0009.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Trosman JR, Weldon CB, Douglas MP, Deverka PA, Watkins JB, Phillips KA. Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:40-46. [PMID: 28212967 PMCID: PMC5319741 DOI: 10.1016/j.jval.2016.09.2402] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. OBJECTIVES To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. METHODS We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. RESULTS We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. CONCLUSIONS As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations.
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Affiliation(s)
- Julia R Trosman
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Franscisco, CA, USA; Center for Business Models in Healthcare, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Christine B Weldon
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Franscisco, CA, USA; Center for Business Models in Healthcare, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael P Douglas
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Franscisco, CA, USA
| | | | | | - Kathryn A Phillips
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Franscisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy, University of California, San Francisco, CA, USA
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Sinha MS, Kesselheim AS. Regulatory Incentives for Antibiotic Drug Development: A Review of Recent Proposals. Bioorg Med Chem 2016; 24:6446-6451. [PMID: 27591793 DOI: 10.1016/j.bmc.2016.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/08/2016] [Accepted: 08/20/2016] [Indexed: 01/30/2023]
Abstract
Two primary regulatory mechanisms have been proposed to incentivize new antibiotic development: (1) changing Food and Drug Administration (FDA) approval processes to expedite antibiotic approval; and (2) offering enhanced possibilities for market exclusivity. Changes to the FDA regulatory approval process include greater reliance on surrogate endpoints such as biomarkers, use of noninferiority hypothesis designs for key preapproval clinical trials, and development of an expedited development track specific for antibiotics called the Limited Population pathway. The second strategy intended to encourage new antibiotic development has been to provide additional market exclusivity incentives based on regulatory approval. While these pathways have some positive attributes, they also present enhanced risks to patients associated with lower regulatory barriers and the market exclusivity incentives may not efficiently direct resources to the true origins of antibiotic innovation.
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Affiliation(s)
- Michael S Sinha
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120, United States
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120, United States.
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Kahn JM, Le TQ. Adoption and de-adoption of drotrecogin alfa for severe sepsis in the United States. J Crit Care 2015; 32:114-9. [PMID: 26777744 DOI: 10.1016/j.jcrc.2015.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/12/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Drotrecogin alfa was a landmark drug for treatment of severe sepsis, yet little is known about how it was adopted and de-adopted during its 10-year period of availability. METHODS We used hospitalization data on fee-for-service Medicare beneficiaries from 2002 to 2011 to characterize trends in the use of drotrecogin alfa in the United States. RESULTS Drotrecogin alfa use peaked at 5.87 per 1000 severe sepsis hospitalizations in 2003 and then steadily declined to 0.94 administrations per 1000 severe sepsis hospitalizations in 2010. Large teaching hospitals were more likely to use drotrecogin alfa than small, nonteaching hospitals. The addition of "add-on payments" to hospitals for using drotrecogin alfa in 2002 was associated with significantly increased use (P < .0001), and the withdrawal of those payments in 2004 was associated significantly decreased use (P < .0001). Neither the publication of international sepsis guidelines with favorable drotrecogin alfa recommendations (in 2004 and 2008) nor the publication of a clinical trial focused on drotrecogin alfa (in 2005) were associated with consistent changes use (P > .05). CONCLUSIONS Drotrecogin alfa use declined over time, with marked changes in use associated with drug-specific financial incentives but not the publication of clinical practice guidelines or clinical trials.
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Affiliation(s)
- Jeremy M Kahn
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
| | - Tri Q Le
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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