Differences Between Physician Social Networks for Cardiac Surgery Serving Communities With High Versus Low Proportions of Black Residents
Differences Between Physician Social Networks for Cardiac Surgery Serving Communities With High Versus Low Proportions of Black Residents
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DOI：
10.1097/mlr.0000000000000291
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发表时间：
2015-02-01
期刊：
影响因子：
3
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Hollingsworth, John M.;Funk, Russell J.;Birkmeyer, John D.
背景资料：与白色患者相比，黑人患者更有可能在低质量医院接受心脏手术，即使他们住得离高质量医院更近。组织干预以缓解这一问题的机会仍然难以捉摸。Objectives：探讨在黑人居民比例高的社区中，医生隔离是导致在获得高质量医院进行心脏手术方面种族差异的一个因素。使用国家医疗保险数据（2008-2011），我们绘制了进行冠状动脉旁路移植手术的医院的医生社交网络，测量了他们的连通程度。然后，我们拟合了一系列多元回归模型，以检查医生联系与每个网络所服务的医院服务区（HSA）中黑人居民比例之间的关联。（即重复连接分数、聚类和外部连接数）。在考虑到医疗保健能力的地区差异后，在黑人居民较多的地区执业的医生的社交网络在许多重要方面不同于黑人居民较少的HSAs。有许多黑人居民的HSAs的医生与其他HSAs相比，彼此之间的重复互动次数较少（P < 0.001）。当这些医生进行互动时，他们倾向于聚集在高度相互联系的同事的较小群体中（P < 0.001）。他们也有较少的互动与医生以外的直接地理区域（P = 0.048）。结论：医生在HSAs与许多黑人居民更孤立的HSAs与黑人居民较少。这种隔离可能会对护理协调和信息共享产生负面影响。因此，有计划的分娩系统改革鼓励少数群体在其现有的地方网络内寻求护理，这可能进一步加剧现有的外科手术差距。
Background: Compared with white patients, black patients are more likely to undergo cardiac surgery at low-quality hospitals, even when they live closer to high-quality ones. Opportunities for organizational interventions to alleviate this problem remain elusive.Objectives: To explore physician isolation in communities with high proportions of black residents as a factor contributing to racial disparities in access to high-quality hospitals for cardiac surgery.Research Design: Using national Medicare data (2008-2011), we mapped physician social networks at hospitals where coronary artery bypass grafting procedures were performed, measuring their degree of connectedness. We then fitted a series of multivariate regression models to examine for associations between physician connectedness and the proportion of black residents in the hospital service area (HSA) served by each network.Measures: Measures of physician connectedness (ie, repeat-tie fraction, clustering, and number of external ties).Results: After accounting for regional differences in healthcare capacity, the social networks of physicians practicing in areas with more black residents varied in many important respects from those of HSAs with fewer black residents. Physicians serving HSAs with many black residents had a smaller number of repeated interactions with each other than those in other HSAs (P < 0.001). When these physicians did interact, they tended to assemble in smaller groups of highly interconnected colleagues (P < 0.001). They also had fewer interactions with physicians outside their immediate geographic area (P = 0.048).Conclusions: Physicians in HSAs with many black residents are more isolated than those in HSAs with fewer black residents. This isolation may negatively impact on care coordination and information sharing. As such, planned delivery system reforms that encourage minorities to seek care within their established local networks may further exacerbate existing surgical disparities.