A Network Analytic Approach to Modeling Variation in Prostate Cancer Care

前列腺癌护理变异建模的网络分析方法

• 批准号: 8296492
• 负责人: Craig Evan Pollack
• 金额: $ 15.66万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296492
• 关键词: Affect; Appointment; Attitude; Award; Behavior; Cancer Control; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical; Clinical Management; Collection; Comprehensive Cancer Center; Data; Diagnosis; Diffusion; Disease; Epidemiology; Ethnic Origin; Exhibits; Face; Funding; Geographic Locations; Goals; Grant; Health Services; Health Services Research; Health behavior; Individual; Internal Medicine; Intervention; Joints; Knowledge; Link; Malignant Neoplasms; Malignant neoplasm of prostate; Maps; Measures; Mediating; Medicare; Medicare claim; Mentors; Methods; Modeling; Outcome; Pathway Analysis; Patient Care; Patients; Pattern; Patterns of Care; Physicians; Positioning Attribute; Primary Care Physician; Process; Provider; Quality of Care; Race; Radiation Oncologist; Radiation therapy; Research Methodology; Research Personnel; Resources; Sampling; Screening procedure; Social Network; Source; Specialist; Structure; Subgroup; Surveys; Techniques; Time; Training; United States; Urologic Cancer; Urologist; Variant; Work; anticancer research; base; cancer care; cancer diagnosis; cancer health disparity; cancer prevention; cancer therapy; effective intervention; follow-up; health disparity; improved; medical schools; men; older men; professor; racial difference; socioeconomics; theories; working group

DESCRIPTION (provided by applicant): Unexplained variation in the clinical management of prostate cancer is recognized as an important problem in cancer treatment. To investigate potential explanations for this variation, the proposed project uses a social network analytic approach to model the connections that exist between physicians caring for patients with prostate cancer. This approach explicitly recognizes the clinical reality that many patients face: they see multiple physicians for their screening, diagnosis, treatment, and follow-up care across a range of clinical venues and at various times. Not only does each physician contribute to the type and quality of care patients receive but also the relationships between physicians within a geographical region may be an important and modifiable determinant of care. The specific aims of this study are: (1) to map the connections between PCPs, urologists, and radiation oncologists as a network and examine whether specialists' positions in the network structure are related to their patient's prostate cancer treatment; (2) to determine whether the network structure helps explain observed differences in prostate cancer treatment between black and white men; and (3) to investigate the determinants of the network structure through a survey of PCPs about their referral decisions. To achieve these aims, this project uses SEER-Medicare claims data and a survey of PCPs. The SEER- Medicare sample consists of men with localized prostate cancer diagnosed from 1995-2005 and their associated PCP and specialist providers. The position of specialists in the cancer care networks will be quantitatively determined and the positions will be related to patient-level variation in the type and quality of cancer care and to racial differences in care. The survey of PCPs will elucidate the factors important in their referral decisions. Understanding observed variations may suggest ways that the network structure may be leveraged to improve quality in cancer care and reduce disparities in outcomes. The candidate, Craig Pollack, MD, MHS is an Assistant Professor in the Division of General Internal Medicine at Johns Hopkins School of Medicine with a joint appointment in the Department of Epidemiology and membership in the Sidney Kimmel Comprehensive Cancer Center. His long-term goal is to become an independent, grant-funded health services researcher in the field of cancer control. His short-term goals are to develop expertise in cancer prevention and control, network analysis, advanced health services research methods, and organizational theory and provider behavior. Dr. Pollack has assembled a mentoring team that includes national leaders in cancer research, urological cancer, health disparities, and network analysis. The proposed project provides Dr. Pollack with the training, mentoring, and resources to become a successful independent investigator dedicated to improving cancer care.

描述（由申请人提供）：前列腺癌临床治疗中无法解释的变异被认为是癌症治疗中的一个重要问题。为了调查这种变化的潜在解释，拟议的项目使用社交网络分析方法来模拟照顾前列腺癌患者的医生之间存在的联系。这种方法明确认识到许多患者面临的临床现实：他们在不同的临床场所和不同的时间见多名医生进行筛查、诊断、治疗和后续护理。每位医生不仅对患者接受的护理类型和质量做出贡献，而且地理区域内医生之间的关系可能是护理的重要且可改变的决定因素。本研究的具体目的是：（1）将PCP、泌尿科医生和放射肿瘤科医生之间的联系绘制成一个网络，并检查专家在网络结构中的位置是否与其患者的前列腺癌治疗相关； （2）确定网络结构是否有助于解释观察到的黑人和白人之间前列腺癌治疗的差异； (3) 通过调查 PCP 的转诊决定来调查网络结构的决定因素。为了实现这些目标，该项目使用 SEER-Medicare 索赔数据和 PCP 调查。 SEER-Medicare 样本由 1995 年至 2005 年诊断出的局限性前列腺癌男性及其相关的 PCP 和专科医生组成。癌症护理网络中专家的职位将被定量确定，并且这些职位将与癌症护理类型和质量的患者水平差异以及护理中的种族差异相关。对 PCP 的调查将阐明影响其转诊决定的重要因素。了解观察到的变化可能会建议如何利用网络结构来提高癌症护理质量并减少结果差异。该候选人克雷格·波拉克（Craig Pollack），医学博士，公共卫生服务硕士，是约翰·霍普金斯大学医学院普通内科部的助理教授，同时兼任流行病学系和西德尼·金梅尔综合癌症中心的会员。他的长期目标是成为癌症控制领域的一名独立的、受赠款资助的卫生服务研究员。他的短期目标是发展癌症预防和控制、网络分析、先进卫生服务研究方法以及组织理论和提供者行为方面的专业知识。波拉克博士组建了一个指导团队，其中包括癌症研究、泌尿系统癌症、健康差异和网络分析领域的国家领导人。拟议的项目为 Pollack 博士提供了培训、指导和资源，使其成为一名成功的独立研究者，致力于改善癌症护理。