Association between a network-based physician linchpin score and cancer patient mortality: a SEER-Medicare analysis.
Association between a network-based physician linchpin score and cancer patient mortality: a SEER-Medicare analysis.
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基于网络的医生关键评分与癌症患者死亡率之间的关联：SEER-Medicare 分析。
DOI：
10.1093/jnci/djad180
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
O'Malley,AJames
中科院分区：
文献类型：
--
作者：
Moen,ErikaL;Schmidt,RachelO;Onega,Tracy;Brooks,GabrielA;O'Malley,AJames
背景癌症患者经常需要多学科团队才能获得最佳的癌症治疗结果。网络分析可以捕捉癌症专家之间的关系，我们开发了一种新的医生关键评分，以表征那些与相同肿瘤学专业的其他医生联系较少的“关键”医生。在这项横断面研究中，我们分析了2016-2017年间被诊断为I期至III期非小细胞肺癌或结直肠癌(CRC)患者的监测、流行病学和最终结果-医疗保险数据。我们收集了患者共享网络，并计算了内科肿瘤学家、放射肿瘤学家和外科医生的关键分数。如果医生的关键得分在其专业领域的前15%以内，他们就被认为是关键。我们使用COX比例风险模型来检验关键医生的治疗与生存期之间的关系，并对其进行2年的随访期。结果：研究队列包括100081例 非小细胞肺癌和9036例结直肠癌患者。接受关键放射肿瘤学家治疗的肺癌患者的死亡风险增加了17%(95%可信区间 = 为1.04至1.32)，而关键的内科肿瘤学家也观察到了类似的趋势。接受关键外科医生治疗的结直肠癌患者的死亡风险增加了22%(95%可信区间 = 为1.03到1.43)。结论在一项对患有非转移性肺癌或结直肠癌的医疗保险受益人的分析中，接受关键外科医生治疗的患者通常生存较差。改进成果的努力可以利用网络分析来确定多学科专家就诊机会减少的领域。
BackgroundPatients with cancer frequently require multidisciplinary teams for optimal cancer outcomes. Network analysis can capture relationships among cancer specialists, and we developed a novel physician linchpin score to characterize “linchpin” physicians whose peers have fewer ties to other physicians of the same oncologic specialty. Our study examined whether being treated by a linchpin physician was associated with worse survival.MethodsIn this cross-sectional study, we analyzed Surveillance, Epidemiology, and End Results–Medicare data for patients diagnosed with stage I to III non-small cell lung cancer or colorectal cancer (CRC) in 2016-2017. We assembled patient-sharing networks and calculated linchpin scores for medical oncologists, radiation oncologists, and surgeons. Physicians were considered linchpins if their linchpin score was within the top 15% for their specialty. We used Cox proportional hazards models to examine associations between being treated by a linchpin physician and survival, with a 2-year follow-up period.ResultsThe study cohort included 10 081 patients with non-small cell lung cancer and 9036 patients with CRC. Patients with lung cancer treated by a linchpin radiation oncologist had a 17% (95% confidence interval = 1.04 to 1.32) greater hazard of mortality, and similar trends were observed for linchpin medical oncologists. Patients with CRC treated by a linchpin surgeon had a 22% (95% confidence interval = 1.03 to 1.43) greater hazard of mortality.ConclusionsIn an analysis of Medicare beneficiaries with nonmetastatic lung cancer or CRC, those treated by linchpin physicians often experienced worse survival. Efforts to improve outcomes can use network analysis to identify areas with reduced access to multidisciplinary specialists.
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