A Network Analytic Approach to Modeling Variation in Prostate Cancer Care

描述（申请人提供）：前列腺癌临床治疗中的不明原因变异被认为是癌症治疗中的一个重要问题。为了研究这种差异的潜在解释，该项目建议使用社会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。这种方法明确地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看到多位医生进行筛查、诊断、治疗和后续护理。每位医生不仅对患者接受的护理的类型和质量有贡献，而且地理区域内医生之间的关系可能是一个重要的和可改变的护理决定因素。本研究的具体目的是：(1)绘制pcp、泌尿科医生和放射肿瘤科医生作为一个网络之间的联系，并检查专家在网络结构中的位置是否与患者的前列腺癌治疗有关；(2)确定网络结构是否有助于解释观察到的黑人和白人男性前列腺癌治疗差异；(3)通过对pcp转诊决策的调查，探讨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pcp的调查。SEER- Medicare样本包括1995-2005年间诊断为局限性前列腺癌的男性及其相关的PCP和专科医生。癌症护理网络中专家的位置将在数量上确定，这些位置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pcp的调查将阐明他们转诊决定的重要因素。了解观察到的变化可能为利用网络结构提高癌症治疗质量和减少结果差异提供途径。候选人Craig Pollack，医学博士，MHS，是约翰霍普金斯医学院普通内科的助理教授，同时担任流行病学部门和Sidney Kimmel综合癌症中心的成员。他的长期目标是在癌症控制领域成为一名独立的、受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、先进卫生服务研究方法、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、健康差距和网络分析方面的国家领导人。拟议的项目为Pollack博士提供培训、指导和资源，使其成为一名成功的独立研究者，致力于改善癌症治疗。

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.