Improving cancer health equity by targeting physician networks

项目总结 居住在农村、社会经济地位较低和少数族裔的癌症患者的预后差异 都有很好的记录，并引起了全国媒体的极大关注。最近的回顾队列 研究报告称，当患者获得统一的医疗服务时，结果的城乡和种族差异最小 强调了癌症护理标准化的关键临床重要性。提供数据 评估对专家的访问权限通常基于个人的人均计数来确定访问权限 专业，没有充分考虑到进入跨学科专家团队的机会。一个相对的 未探索的研究领域是癌症专家之间的关系可以被描述的程度 然后有针对性地标准化获得癌症护理的机会，减少癌症健康差距，并改善患者 结果。通过基于患者共享和地理位置评估医生之间的关系 在管理数据中观察到的邻近模式，我们建议将我们团队的专业知识应用于网络 分析和癌症护理，为评估患者获得癌症护理的机会提供一个框架，其中认识到 内科肿瘤学、放射和外科专家之间的协调。我们的目标是开发和应用 新的网络测量-关键中心性-识别癌症专家，他们是唯一的 他们的同类在邻居的关系中。我们建议通过以下方法来评估医生关键中心性的变化 癌症患者的种族和地理变量，建立在之前的工作表明种族差异的基础上 在美国各城市和农村地区，这一比例差异很大。我们将进一步评估两国之间的关联 医生的中心地位和及时治疗与癌症死亡率密切相关。增加访问权限的一个途径 专科护理是通过癌症专家前往二级诊所，通常是乡村医院 在一个太小的社区里无法支持一个全职专家。然而，人们对旅行的影响知之甚少 医生对医生和患者之间现有关系获得协调的癌症护理的看法存在差距 在知识方面，我们的建议将解决。在针对农村地区的分析中，我们将评估 医生旅行者影响医生网络结构和患者结局。最后，我们将进行一次 为进一步发展关键中心性和作为干预的网络算法提供信息的定性研究 以改善癌症护理。我们开发的算法将为卫生系统提供关于 组织癌症护理提供者为其提供服务，并可帮助指导干预和分配 适当的资源。总而言之，该提案使用网络分析来捕捉基本特征 对癌症患者的护理质量进行评估，目标是将理论和实践联系起来，以改善获得和 网络引导干预的结果。

PROJECT SUMMARY Disparities in outcomes among cancer patients who are rural-residing, with lower SES, and a racial minority are well-documented and have garnered significant national media attention. Recent retrospective cohort studies reported minimal rural/urban and racial disparities in outcomes when patients had uniform access to care, highlighting the critical clinical importance of standardizing access to cancer care. Data made available which evaluates access to specialists typically determines access based on a per capita count of individual specialties, which does not adequately capture access to interdisciplinary teams of specialists. A relatively unexplored area of study is the extent to which relationships between cancer specialists can be characterized and then targeted to standardize access to cancer care, reduce cancer health disparities, and improve patient outcomes. By assessing the relationships between physicians based on patient-sharing and geographic proximity patterns observed in administrative data, we propose to apply our team’s expertise in network analysis and cancer care to provide a framework for evaluating patient access to cancer care which recognizes the coordination across medical oncology, radiation, and surgical specialists. We aim to develop and apply a novel network measure– linchpin centrality – which identifies cancer specialists who are the only specialist of their kind among their neighbors’ ties. We propose to evaluate variation of physician linchpin centrality by cancer patient race and geographic variables, building on previous work demonstrating that racial disparities vary significantly across US cities and rural subregions. We will further evaluate associations between physician linchpin centrality and timely treatment and cancer mortality. One avenue for increasing access to specialist care is through cancer specialists traveling to a secondary practice location, typically a rural hospital in a community too small to support a full-time specialist. However, little is known about the impact of traveling physicians on existing relationships between physicians and patient access to coordinated cancer care, a gap in knowledge our proposal will address. In analyses specific to rural areas, we will assess the extent to which physician travelers impact physician network structure and patient outcomes. Finally, we will conduct a qualitative study to inform further development of linchpin centrality and a network algorithm as an intervention to improve cancer care. The algorithm we develop will provide health systems with actionable data on the organization of cancer care providers for their catchment and can help guide interventions and allocate resources appropriately. In conclusion, this proposal uses network analysis to capture essential characteristics of the quality of care for cancer patients, with the goal of bridging theory and practice to improve access and outcomes with a network-guided intervention.