Physician Networks for Diabetic Lower Extremity Wounds

摘要/摘要 糖尿病下肢（DLE）伤口影响高达34%的糖尿病成人，并与 显著的临床发病率/死亡率、增加的医疗保健利用率和更高的护理成本。然而，在这方面， DLE伤口中持续存在的种族/民族和社会经济差异仍然没有得到很好的解决， 了解医生服务的利用情况和医生网络在观察到的差异中的作用。这 建议响应PAR-20-310，少数民族健康和健康差异的卫生服务研究，通过 开展一项全国性的评估，评估不同种族/民族和社会经济群体在医疗保健利用方面的差异， DLE伤口的患者，并评估医生网络和转诊模式在 观察差异。通过兰德AHRQ U19卫生系统绩效卓越中心， 研究将利用几个医疗保险数据源，独特的医生级初步数据， 改进受益人种族/族裔分类的方法。这项研究将集中在医疗保险的收费服务 65岁及以上的受益人，有新的DLE伤口，并跟踪纵向医疗保健利用情况 在初始伤口诊断后的6个月期间，在多个临床环境中提供服务。在目标1中， 我们将使用多变量回归技术来评估种族/民族和社会经济差异， 初步DLE伤口诊断后的医疗保健利用率。然后，我们将映射和描述医生网络 和转诊模式，并检查网络/转诊模式特征对 医疗保健利用差异（目标2）。最后，在目标3中，我们将模拟网络/推荐模式的变化 特征，并识别哪些特征具有更强的视差减少效果，因此， 有利于干预发展。拟议的研究将确定可能修改的方面， 医生网络和转诊模式导致了DLE伤口护理中观察到的差异。结果将 告知有关医生网络充分性、卫生系统组织和付款人激励的政策 可以提高DLE伤口患者的护理质量，并减少医疗保健利用的差异。的 项目团队由多名NIH资助的研究人员组成，他们在健康差异研究方面具有丰富的专业知识， 索赔数据、统计方法和临床背景知识的网络分析。

Summary/Abstract Diabetic lower extremity (DLE) wounds affect up to 34% of adults with diabetes and are associated with substantial clinical morbidity/mortality, increased healthcare utilization, and higher cost of care. However, persistent racial/ethnic and socioeconomic disparities among DLE wounds remain poorly addressed, and little is known about the utilization of physician services and role of physician networks in observed disparities. This proposal responds to PAR-20-310, Health Services Research on Minority Health and Health Disparities, by conducting a national evaluation of racial/ethnic and socioeconomic disparities in healthcare utilization among patients with DLE wounds, and assessing the role that physician networks and referral patterns play in observed disparities. Through the RAND AHRQ U19 Center of Excellence on Health System Performance, our study will leverage several Medicare data sources, unique physician-level preliminary data, and innovative methods to improve beneficiary classification of race/ethnicity. The study will focus on Medicare fee-for-service beneficiaries aged 65 years and older with a new DLE wound and track longitudinal utilization of healthcare services across multiple clinical settings during the 6-month period following initial wound diagnosis. In Aim 1, we will use multivariable regression techniques to evaluate racial/ethnic and socioeconomic disparities in healthcare utilization after initial DLE wound diagnosis. Then, we will map and characterize physician networks and referral patterns for DLE wounds and examine the effects of network/referral pattern characteristics on healthcare utilization disparities (Aim 2). Finally, in Aim 3, we will simulate changes to network/referral pattern characteristics and identify which characteristics have stronger disparity reducing effects, and therefore, are amenable to intervention development. The proposed study will identify potentially modifiable aspects of physician networks and referral patterns that contribute to observed disparities in DLE wound care. Results will inform how policy regarding physician network adequacy, health system organization, and payer incentives can improve quality of care for patients with DLE wounds and reduce disparities in healthcare utilization. The project team consists of multiple NIH funded researchers with ample expertise in health disparities research, network analysis of claims data, statistical methods, and knowledge of clinical context.