Effects of Physician Social Networks on Surgical Quality, Safety, and Costs

描述（由申请人提供）：不同医疗机构在手术死亡率和每次手术费用方面存在很大差异，这表明有改进的机会。虽然已经推出了各种各样的举措来提高手术护理的安全性、质量和成本效益，但这些努力几乎完全集中在外科医生在手术室及其后的活动上。然而，越来越多的人认识到外科医生、推荐的初级保健医生（PCP）和咨询医生之间的护理和沟通的协调是至关重要的。因此，优化手术护理将需要测量和理解所有参与手术事件的医生提供的护理及其相互作用的能力。在这种背景下，候选人（Dr. John M. Hollingsworth）试图描述和评估医生社会网络提供外科护理的有效性。候选人是密歇根大学的泌尿科医生和健康服务研究员，他将利用这一提议扩大他的研究议程的科学和临床范围，并促进他发展成为一名独立的研究者。在支持期间，他将在几个学科上进行额外的教学指导，包括网络理论、卫生经济学、卫生组织和政策等研究生和博士水平的课程。他还将有充足的机会接受指导，以项目为基础的学习，包括高级统计建模和社会网络分析技术的实际应用。研究计划有三个具体目标。具体目标1：绘制提供外科护理的医生社会网络。根据密歇根蓝十字蓝盾保险公司和密歇根医疗保险计划（2008-2010）的档案，候选人将确定接受四种常见住院手术中的一种的受益人。根据手术类型，他将使用一种经过验证的方法来绘制进行这些手术的医院的医生社交网络，在一系列本地和全球网络属性的多个方向上对它们进行表征。他假设，与服务于农村地区的医生社交网络相比，城市医院的医生数量更多，但他们的平均距离相似。他认为，照顾女性和黑人病人的医生社交网络将分别比照顾男性和白人病人的医生社交网络少。具体目的2：评价医师社交网络对外科护理安全和质量的影响。然后，候选人将研究医生联系与医院安全文化/团队合作氛围之间的关系。他还将评估手术质量指标（即手术死亡率、再入院率和术后并发症）与手术发作3个阶段的局部网络特性之间的关系。他假设，外科医生、PCP转诊医生和咨询师倾向于聚集在一起的网络营造了一种安全的环境。他认为，虽然外科医生的中心地位在手术阶段具有较低的发病率和死亡率，但在过渡阶段，更大的外科医生- pcp结合强度导致更少的并发症和再入院。具体目标3：检查医生社会网络对外科护理成本的影响。最后，候选人将量化由不同程度的医生连接的网络所照顾的患者的总支出。他将通过比较全球网络属性的组件支付来探索节省的具体来源。他假设在不同的网络之间，总情节支出存在显著差异。他认为，有凝聚力和密集的网络可以从各种来源积累储蓄，包括降低急性期后护理的费用。拟议研究的完成将告知医疗保险和医疗补助服务中心以及其他大型支付方，加强医生之间的互动在多大程度上可能对外科护理的安全性、质量和成本产生影响。更广泛地说，这项建议的发现将为研究人员、临床医生领导者和政策制定者提供更多的见解，了解不同类型医生之间关系的本质及其对医疗保健服务的重要性。

DESCRIPTION (provided by applicant): Substantial variation in surgical mortality rates and costs per surgical episode exists across providers, suggesting opportunities for improvement. While a variety of initiatives have been launched to enhance the safety, quality, and cost-efficiency of surgical care, these efforts focus almost exclusively on the surgeon's activities in the operating room and immediately afterward. However, there is growing recognition that coordination of care and communication among the surgeon, the referring primary care physician (PCP), and consultants are crucial. As such, optimizing surgical care will require the ability to measure and understand the care delivered by all physicians involved in the surgical episode and their interactions. In this context, the candidate (Dr. John M. Hollingsworth) seeks to characterize and evaluate the effectiveness of physician social networks that deliver surgical care. The candidate, a urologist and health services researcher at the University of Michigan, will leverage this proposal to broaden the scientific and clinical scope of his research agenda, and to facilitate his development into an independent investigator. During the period of support, he will pursue additional didactic instruction in several disciplines, including graduate- and doctoral-level courses in network theory, health economics, and healthcare organization and policy. He will also have ample opportunities for mentored, project-based learning, including the hands-on application of advanced statistical modeling and the techniques of social network analysis. The research plan has 3 Specific Aims. Specific Aim 1: To map physician social networks that deliver surgical care. With files from Blue Cross Blue Shield of Michigan and Michigan Medicare plans (2008-2010), the candidate will identify beneficiaries undergoing 1 of 4 common inpatient surgical procedures. By surgery type, he will use a validated method to graph physician social networks at hospitals where these procedures are performed, characterizing them in a number of directions across a range of local and global network properties. He hypothesizes that, compared with physician social networks serving rural areas, those at urban hospitals have a larger number of physicians, but their average distances are similar. He posits that physician social networks that care for female and black patients will be sparser than those for male and white patients, respectively. Specific Aim 2: To evaluate the effect of physician social networks on surgical care safety and quality. The candidate will then examine the association between physician connectedness and a hospital's safety culture/teamwork climate. He will also assess for a relationship between measures of surgical quality (i.e., operative mortality, readmissions, and postoperative complications) and local network properties across 3 phases of the surgical episode. He hypothesizes that networks in which the surgeon, referring PCP, and consultant tend to cluster together foster environments of safety. He posits that while surgeon centrality confers lower morbidity and mortality during the operative phase, greater surgeon-PCP tie strength leads to fewer complications and readmissions in the transition phase. Specific Aim 3: To examine the impact of physician social networks on the costs of surgical care. Finally, the candidate will quantify total expenditures for patients cared for by networks with varying levels of physician connectedness. He will explore specific sources of savings by comparing component payments over global network properties. He hypothesizes that significant variation in total episode expenditures exists between networks. He posits that cohesive and dense networks accrue savings from a variety of sources, including lower payments for post-acute care. Completion of the proposed research will inform the Centers for Medicare and Medicaid Services and other large payers on the extent to which strengthening interactions between physicians, in general, might impact on the safety, quality, and costs of surgical care. More broadly, findings from this proposal will provide researchers, clinician leaders, and policymakers with additional insight into the nature of relationships among different types of physicians and their importance for healthcare delivery.