Social Networks and the Spread of Cancer Care Practices

描述(由申请人提供)：医生，无论是直接通过他们提供的服务，还是间接通过他们订购的服务，都塑造了美国绝大多数的医疗保健利用。长期以来，人们对医生决策的决定因素一直非常感兴趣，因为优化医生决策有可能提高美国医疗保健的质量，同时还可以通过消除不必要的服务来控制成本。对医生决策的一个影响在很大程度上被忽视了，这来自于医生网络对个人医生决策的影响。在这里，我们使用的术语是技术意义上的“网络”，指的是共享病人和信息的初级保健和专科医生的非正式网络，而不是正式隶属于健康计划或医院的所有医生的正式网络。凭借共享患者，这些网络可以通过经验来定义。医生网络有可能影响个别医生的决策，但这种影响很少被研究。在这一应用中，我们建议开发一个随时间推移的医生网络的纵向数据库，并应用我们在定义和描述医生网络中开发的方法来了解癌症护理实践在这些网络中的扩散。我们建议使用2005至2009年的联邦医疗保险数据来评估医生网络对肿瘤护理以及临终关怀中癌症患者临终关怀使用创新的采用和使用的差异的贡献。我们还计划进行额外的分析，将监测、流行病学和最终结果(SEER)计划的数据与我们在这些地区的医生网络数据结合起来，以检查采用和使用新的癌症治疗方法的适当性。该建议的具体目的是：1)检查网络属性预测新癌症疗法传播的程度，重点是癌症新生物疗法的传播；2)检查网络属性预测临终关怀使用的局部差异的程度；以及3)检查网络属性预测新疗法传播的适当性的程度。

DESCRIPTION (provided by applicant): Physicians, both directly through services they provide and indirectly through the services that they order, shape the vast majority of health care utilization in the US. There has long been intense interest in the determinants of physician decision making because optimizing physician decisions has the potential to improve the quality of US health care while also controlling costs by eliminating the use of unnecessary services. One influence on physician decision making that has largely been ignored derives from the influence of networks of physicians on individual physician decision making. Here, we are using the term "network" in a technical sense to refer to informal networks of primary care and specialist physicians who share patients and information, rather than formal networks of all of the physicians formally affiliated with a health plan or hospital. By virtue of sharing patients, these networks can be defined empirically. Networks of physicians have the potential to influence an individual physician's decision making, but such influences have rarely been studied. In this application, we propose to develop a longitudinal database of physician networks over time and to apply the methods we have developed in defining and describing physician networks to understand diffusion of cancer care practices across these networks. We propose to use Medicare data from 2005 through 2009 to evaluate the contribution of physician networks to variations in the adoption and use of innovations in oncology care as well as hospice use for terminally-ill cancer patients. We also plan additional analyses that will combine data from the Surveillance, Epidemiology and End Results (SEER) Program with our data on physician networks in those areas to examine the appropriateness of the adoption and use of new cancer treatments. The specific aims of the proposal are to: 1) Examine the extent to which network properties predict diffusion of new cancer therapies, focusing on the diffusion of new biologic therapies for cancer; 2) Examine the extent to which network properties predict local variations in the use of hospice; and 3) Examine the extent to which network properties predict the appropriateness of the diffusion of new therapies.