Variation in patient-sharing networks of physicians across the United States.
Variation in patient-sharing networks of physicians across the United States.
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DOI：
10.1001/jama.2012.7615
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发表时间：
2012-07-18
影响因子：
120.7
通讯作者：
Christakis, Nicholas A.
中科院分区：
文献类型：
--
作者：
Landon, Bruce E.;Keating, Nancy L.;Barnett, Michael L.;Onnela, Jukka-Pekka;Paul, Sudeshna;O'Malley, A. James;Keegan, Thomas;Christakis, Nicholas A.
医生被嵌入在非正式的网络中，导致他们分享病人，信息和行为。我们使用新的方法来识别医生之间的专业网络，研究这些网络如何在地理区域之间变化，并确定与医生联系相关的因素。使用社会网络分析的方法，我们使用2006年的医疗保险管理数据，研究了51个医院转诊地区（HRR）的68，288名执业医生的4，586，044名医疗保险受益人。为51个HRR中的每一个构建了描述医生之间联系的不同网络（基于共享患者定义）。HRR之间网络特征的变化以及与连接的医生相关的因素。每个HRR的医生数量范围从ND的迈诺特的135名到MA的波士顿的8，197名。有很大的变化，在网络特性的HRR。例如，在所有HRR中，调整后的中位程度（每100名医疗保险受益人中每位医生与其他医生联系的数量）为27.3，范围从11.7到54.4;此外，初级保健医生（PCP）相对中心性（中心PCP相对于其他医生在网络中的位置）范围从0.19到1.06。相互有联系的医生更有可能在同一家医院工作（96.0%的连接医生对与69.2%的未连接医生对，p<0.001，校正率比= 0.12，95%置信区间0.12，0.12）），并且在地理上更接近（有连接的平均办公室距离为13.2英里，没有连接的为24.2英里，p<0.001）。在种族或疾病负担方面，连接的医生也比未连接的医生拥有更多相似的患者面板。例如，有联系的医生对在他们的两个患者小组中黑人患者的百分比平均差异为8.8个百分点，而没有联系的医生对的差异为14.0个百分点（p<0.001）。网络特征因地理区域而异。医生倾向于与具有相似医生水平和患者面板特征的其他医生共享患者。
Physicians are embedded in informal networks that result in their sharing patients, information, and behaviors. We use novel methods to identify professional networks among physicians, to examine how such networks vary across geographic regions, and to determine factors associated with physician connections. Using methods adopted from social network analysis, we used Medicare administrative data from 2006 to study 4,586,044 Medicare beneficiaries seen by 68,288 active physicians practicing in 51 hospital referral regions (HRRs). Distinct networks depicting connections between physicians (defined based on shared patients) were constructed for each of the 51 HRRs. Variation in network characteristics across HRRs and factors associated with physicians being connected. The number of physicians per HRR ranged from 135 in Minot, ND to 8,197 in Boston, MA. There was substantial variation in network characteristics across HRRs. For example, the median adjusted degree (number of other physicians each physician was connected to, per 100 Medicare beneficiaries) across all HRRs was 27.3, and ranged from 11.7 to 54.4; also, primary care physician (PCP) relative centrality (how central PCPs were in the network relative to other physicians) ranged from 0.19 to 1.06. Physicians with ties to each other were far more likely to be based at the same hospital (96.0% of connected physician pairs versus 69.2% of unconnected pairs, p<.001, adjusted rate ratio=.12, 95% confidence interval .12,.12)), and were in closer geographic proximity (mean office distance of 13.2 miles for those with connections versus 24.2 for those without, p<.001). Connected physicians also had more similar patient panels, in terms of the race or illness burden, than unconnected physicians. For instance, connected physician pairs had an average difference of 8.8 points in the percentage of black patients in their two patient panels compared with a difference of 14.0 percentage points for unconnected physician pairs (p<.001). Network characteristics vary across geographic areas. Physicians tend to share patients with other physicians with similar physician-level and patient-panel characteristics.
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影响因子：
4.4
作者：
Kinchen, KS;Cooper, LA;Powe, NR
通讯作者：
Powe, NR
影响因子：
39.2
作者：
Pham HH;O'Malley AS;Bach PB;Saiontz-Martinez C;Schrag D
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Schrag D
影响因子：
5.7
作者：
Barnett, Michael L.;Keating, Nancy L.;Landon, Bruce E.
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Landon, Bruce E.
影响因子：
39.2
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Fisher, ES;Wennberg, DE;Pinder, EL
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Pinder, EL
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5.7
作者：
Keating, Nancy L.;Ayanian, John Z.;Marsden, Peter V.
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Marsden, Peter V.