A Network Analytic Approach to Modeling Variation in Prostate 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可能原因，拟议的项目使用了一种社会网络分析方法来模拟前列腺癌患者护理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：他们在不同的临床地点和不同的时间向多名医生进行筛查、诊断、治疗和后续护理。每个医生不仅对患者接受的护理类型和质量做出贡献，而且一个地理区域内的医生之间的关系也可能是一个重要的和可改变的护理决定因素。这项研究的具体目的是：(1)绘制PCP、泌尿科医生和放射肿瘤学家之间的网络关系图，并检查专家在网络结构中的位置是否与他们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黑人和白人男性在前列腺癌治疗方面的观察到的差异；以及(3)通过对PCP关于转诊决策的调查，调查网络结构的决定因素。为了实现这些目标，该项目使用了SEER-Medicare索赔数据和对初级保健医生的调查。SEER-Medicare样本包括1995-2005年间被诊断为局限性前列腺癌的男性及其相关的PCP和专家提供者。癌症护理网络中专家的职位将是定量确定的，职位将与癌症护理类型和质量的患者水平差异以及护理的种族差异有关。对初级保健医生的调查将阐明在他们的转介决定中重要的因素。了解观察到的变化可能会提出利用网络结构来提高癌症护理质量和减少结果差异的方法。候选人克雷格·波拉克，医学博士，医学硕士，约翰·霍普金斯医学院普通内科助理教授，兼任流行病学系成员和西德尼·基梅尔综合癌症中心成员。他的长期目标是成为癌症控制领域的一名独立的、由赠款资助的卫生服务研究人员。他的短期目标是发展癌症预防和控制、网络分析、先进的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，成员包括癌症研究、泌尿系癌症、健康差异和网络分析方面的国家领导者。拟议的项目为波拉克博士提供了培训、指导和资源，使他成为一名致力于改善癌症护理的成功的独立调查员。

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.