The diffusion of medical information in hospitals, patients and physicians

Medical advancement is caused by the accumulation and dissemination of new scientific information. Patient diagnosis, medical treatment and health outcomes often depend upon the application of information at the hospital, patient and physician levels. This dissertation examines the impact of new clinical information at the hospital level, the impact of advertising information at the patient level and the utilization of quality care practices at the physician level. The first paper examines the impact of the number of surgeries at a hospital on the application of new clinical information to hospital practices. Information acquisition is a fixed cost, but benefits accrue per surgery, therefore research adoption is more likely among hospitals performing more total surgeries. The cases of carotid endarterectomy (CEA) and angioplasty during heart attack (PTCA) show that hospitals with more surgeries better adhered to the clinical literature. The data supports the hypothesis that there is more research adoption at high volume hospitals. The second paper uses parameter estimates from survey, epidemiological and experimental data to model the costs and benefits of new users of anti-depressants due to direct to consumer advertising (DTCA) for the case of depression. This study shows that 94% of new anti-depressant use due to DTCA is from non-depressed individuals. However, the average health benefit to each appropriate new user is 63-fold greater than the average cost per treatment, resulting in a positive net benefit of over $72 million. The cost to benefit ratio of DTCA could be improved through better targeting of advertisements and higher quality treatment of depression. The final paper examines the determinants of the undermanagement of osteoporosis after hip or wrist fracture in females over age 65. Using a retrospective cohort, I find that patients older than 90, and black patients were less likely than average to be treated for osteoporosis. Female prescribers were more likely than male prescribers to manage osteoporosis and bisphosphonate treatment before fracture was the best predictor of bisphosphonate treatment after fracture. Our findings highlight that prescribers of all experience levels, specialties and locations need to improve osteoporosis management after hip or wrist fracture.