Physician Social Networks and Variation in Rates of Complications After Radical Prostatectomy
Physician Social Networks and Variation in Rates of Complications After Radical Prostatectomy
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DOI：
10.1016/j.jval.2014.04.011
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发表时间：
2014-07-01
期刊：
影响因子：
4.5
通讯作者：
Armstrong, Katrina
中科院分区：
文献类型：
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作者：
Pollack, Craig Evan;Wang, Hao;Armstrong, Katrina
目标：对地理区域内和地理区域间的护理差异仍然知之甚少。这篇文章的目的是研究医生的社交网络是否与根治性乳腺癌切除术后并发症的发生率相关。研究方法：在五个城市，我们构建了医生网络的基础上，他们共享的病人在2004 - 2005年的监测，流行病学和最终结果-医疗保险数据从这些网络中，我们确定了泌尿科医生的亚组谁最频繁地分享病人彼此。在接受根治性前列腺切除术的局限性前列腺癌患者中，我们使用广义线性混合效应模型进行多水平分析，以检查医生网络结构以及网络亚组的具体特征是否与30天和晚期泌尿系统并发症的发生率以及在考虑患者水平的社会人口统计学、临床因素和泌尿科患者数量后的长期尿失禁相关。结果：网络包括2677名男子在五个城市谁接受了根治性乳房切除术。各网络亚组之间未校正的30天手术并发症发生率各不相同，从城市1各网络亚组之间并发症发生率的18.8个百分点差异到城市5的26.9个百分点差异。在未校正的晚期泌尿系统并发症和长期尿失禁的发生率方面，各亚组之间也存在很大的差异。网络亚组特征、平均泌尿科医师集中度和患者种族构成与手术并发症的发生率显著相关。结论：使用监测、流行病学和最终结果-医疗保险数据对医生网络进行分析，可以深入了解局部前列腺癌并发症发生率的变化。如果得到验证，这些方法可用于未来的质量改进干预措施。
Objectives: Variation in care within and across geographic areas remains poorly understood. The goal of this article was to examine whether physician social networks-as defined by shared patients-are associated with rates of complications after radical prostatectomy. Methods: In five cities, we constructed networks of physicians on the basis of their shared patients in 2004-2005 Surveillance, Epidemiology and End Results-Medicare data From these networks, we identified subgroups of urologists who most frequently shared patients with one another. Among men with localized prostate cancer who underwent radical prostatectomy, we used multilevel analysis with generalized linear mixed-effect models to examine whether physician network structure-along with specific characteristics of the network subgroups-was associated with rates of 30 day and late urinary complications, and long-term incontinence after accounting for patient-level sociodemographic, clinical factors, and urologist patient volume. Results: Networks included 2677 men in five cities who underwent radical prostatectomy. The unadjusted rate of 30 day surgical complications varied across network subgroups from an 18.8 percentage-point difference in the rate of complications across network subgroups in city 1 to a 26.9 percentage-point difference in city 5. Large differences in unadjusted rates of late urinary complications and long-term incontinence across subgroups were similarly found. Network subgroup characteristics average urologist centrality and patient racial composition were significantly associated with rates of surgical complications. Conclusions: Analysis of physician networks using Surveillance, Epidemiology and End Results-Medicare data provides insight into observed variation in rates of complications for localized prostate cancer. If validated, such approaches may be used to target future quality improvement interventions.