Improving cancer health equity by targeting physician networks

通过瞄准医生网络改善癌症健康公平

• 批准号: 10451689
• 负责人: Erika Moen
• 金额: $ 38.32万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10451689
• 关键词: Address; Administrator; Algorithms; Area; Attention; Cancer Patient; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Clinical; Colorectal Cancer; Communities; Data; Development; General Practitioners; Geography; Goals; Health Policy; Health Services Accessibility; Health system; Healthcare; Improve Access; Incidence; Individual; Intervention; Interview; Knowledge; Link; Location; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medical Oncology; Medicare; Medicare claim; Modeling; Network-based; Oncologist; Oncology; Operative Surgical Procedures; Outcome; Output; Pathway Analysis; Patient-Focused Outcomes; Patients; Pattern; Perception; Physicians; Policies; Quality of Care; Race; Radiation; Reporting; Resources; Retrospective cohort study; Rural; Rural Hospitals; Services; Socioeconomic Status; Specialist; Standardization; Structure; Testing; Time; Travel; Variant; Work; barrier to care; base; cancer care; cancer health disparity; cancer therapy; care delivery; care providers; disparity reduction; health equity; improved; improved outcome; informant; innovation; insight; low socioeconomic status; malignant breast neoplasm; medical specialties; models and simulation; mortality; novel; outreach; patient oriented; racial disparity; racial minority; recruit; rural area; rural disparities; rural patients; rurality; simulation; socioeconomic disparity; socioeconomics; teleoncology; theories; underserved area; urban disparity

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.

项目摘要 居住在农村、社会经济地位较低和少数种族的癌症患者的结局差异 有据可查，并引起了全国媒体的广泛关注。近期回顾性队列 研究报告称，当患者获得相同的治疗时， 癌症护理标准化的重要临床意义。提供的数据 它评估专家的访问，通常根据个人的人均计数来确定访问。 专业，这并没有充分捕捉到跨学科的专家团队的机会。相对 一个尚未探索的研究领域是癌症专家之间的关系可以在多大程度上被描述 然后有针对性地标准化癌症护理的获取，减少癌症健康差异， 结果。通过评估基于患者共享和地理位置的医生之间的关系 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，以提供评估患者获得癌症护理的框架， 肿瘤内科、放射科和外科专家之间的协调。我们的目标是开发和应用一个 新的网络测量-关键中心-确定癌症专家谁是唯一的专家， 他们的邻居之间的关系。我们建议通过以下方式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，建立在以前的工作表明，种族差异， 在美国的城市和农村地区差异很大。我们将进一步评估 医生的关键中心地位和及时治疗以及癌症死亡率。一个增加获得 专科护理是通过癌症专家前往二级诊所，通常是农村医院 在一个太小的社区，以支持全职专家。然而，人们对旅行的影响知之甚少 医生之间的现有关系医生和患者获得协调的癌症护理，差距 我们的建议将解决。在对农村地区的具体分析中，我们将评估 医生旅行者影响医生网络结构和患者结果。最后，我们将进行一次 定性研究，为进一步开发关键中心性和网络算法作为干预提供信息 to improve改善cancer癌症care护理.我们开发的算法将为卫生系统提供有关 组织癌症护理提供者为其服务，并可以帮助指导干预措施和分配 适当的资源。总之，本提案使用网络分析来捕捉基本特征 的癌症患者的护理质量，目标是弥合理论和实践，以改善获得和 通过网络引导的干预措施取得成果。