Innovation in Domestic Health Research

Faculty director: Janet Currie, Henry Putnam Professor of Economics and Public Affairs

CHW’s Program on U.S. Health Policy sponsors research and activities addressing aspects of domestic health care and health policy. The Program supports innovative faculty and student research, conferences, policy forums and special issues in health policy journals. Since its inception in 2011, after receiving a generous gift from Daniel Spitzer ’79 and Eliot Spitzer ’81, the Program has funded 15 faculty projects. The active projects are:

“Community-Wide Acquisition of Medical Knowledge Under Conditions of Risk and Uncertainty.” Principal Investigator: Alin Coman, Princeton University

“Epidemiology of Antibiotic Use in US Hospitals.” Principal Investigators: Simon Levin and Ramanan Laxminarayan, Princeton University

“Aging and Work: The Health Consequences.” Principal Investigator: W. Bentley MacLeod, Columbia University

“Policy and Health Implications of Novel Genetic Variants in the Fragile Families and Child Wellbeing Study.” Principal Investigators: Daniel Notterman and Sara McLanahan, Princeton University

Program on U.S. Health Policy: Project Spotlights

“Community-wide Acquisition of Medical Knowledge Under Conditions of Risk and Uncertainty.” Principal Investigator: Alin Coman, Princeton University

The diffusion of accurate knowledge about diseases in the population at large is of critical concern to public health officials. This project is aimed at exploring medical information search, acquisition, and propagation in fully mapped social networks. By building on recent psychological findings, we propose an empirical framework to investigate: (1) How does the perceived risk of infection influence the lay public’s knowledge acquisition following media exposure? and (2) How can policy makers and program planners design behaviorally grounded strategies for efficient information dissemination? The proposed research would constitute the first attempt to weave the burgeoning psychological literature on information propagation with well-established social network approaches to understand medical knowledge acquisition under conditions of risk and uncertainty

“Epidemiology of Antibiotic Use in US Hospitals.” Principal Investigators: Simon Levin and Ramanan Laxminarayan, Princeton University

Though various interventions to improve antimicrobial use have been developed, their implementation in the inpatient setting has been hampered by a lack of data on the epidemiology of antimicrobial use—that is, how hospitalists make decisions to start, stop, and change antimicrobial therapy. A deeper understanding of what information prompts the start and subsequent adjustments to therapy is critical to ongoing efforts to minimize unnecessary and inappropriate antimicrobial use. A strategy recommended by the CDC calls for the re-evaluation of empirically-started antimicrobials as soon as warra

nted by clinical evidence. Yet, there is no information from multi-center studies on how frequently antibiotics are continued despite microbiologic or imaging studies showing no sign of infection. Knowing how commonly this occurs and the factors that are associated with decisions to stop antimicrobials could inform interventions to help improve prescribing practices in healthcare facilities.

This project aims to characterize the general epidemiology of antibiotic use in the selected hospitals and incentives for application of infection control. The research relies on an earlier effort funded by the CDC that uses full chart abstractions to capture detailed information on antimicrobial prescriptions, patient’s clinical information at the time of the prescription, subsequent changes to the antimicrobial therapy, and clinical information at the time antimicrobial prescription changes are made in hospitals. We have collected data from six acute-care facilities that vary with respect to location, size, type, and presence of antibiotic stewardship programs. We are using these existing chart-review data from the six facilities to characterize the general epidemiology of antibiotic use in the selected hospitals.

In related work that is forthcoming in the Proceedings of the National Academies of Science, we have examined subsidy policies that could encourage greater infection control to prevent the spread of antimicrobial resistance in hospitals. 

State Health Reform & Value Strategies 

Our programs assist states with health reform implementation and to spur innovation in health care access, delivery and cost containment. Learn more about state health reform.