The Role of Physician Networks on Racial Disparities in Intensity of Care for Dementia Patients

项目总结 阿尔茨海默病和其他相关痴呆(ADRD)被广泛认为是老年人口发病率和死亡率的主要原因。患病率存在种族差异，老年非裔美国人患ADRD的可能性是老年白人的两倍，在确诊时症状更严重。ADRD患者的治疗强度因种族而异，包括接受的医疗服务的差异，如药物使用和临终护理模式。例如，非洲裔美国人在生命末期放置喂养管的风险是白人患者的1.77倍。虽然不同种族和民族的患者偏好的差异是有记录的，但我们知识中的一个主要差距是医生执业特征对差异有什么作用。虽然可能存在差异，因为同一名医生对非裔美国人和白人患者的治疗方式不同，但另一种选择可能是，不同种族的ADRD患者主要由不同的医生治疗，他们对痴呆症或少数族裔的经历各不相同。此外，看少数族裔痴呆症患者的医生可能在完全不同的医生“网络”中，这意味着少数族裔看医生与具有诊断和治疗痴呆症患者的专门能力的提供者有不同的联系。 通过借鉴为研究社会网络而开发的方法，可以研究医生职业联系对行为的影响。社会网络是社会互动和个人或职业关系的结构性表现。对于医生来说，社交网络由与他们分享信息的同事组成，可以通过推断医生分享患者时的关系来衡量这一点。R03的目标是开发初步数据和方法，以研究医生的社会网络对向患有ADRD的白人和非裔美国人医疗保险受益人提供的临终关怀(EOL)方面的差异的影响。我们建议发展为痴呆症患者提供EOL护理的医生的社会网络(按种族分层)来解决这些问题，并研究这些网络如何与该护理的质量和种族差异相关。因此，本R03旨在：(1)构建和总结痴呆症患者的内科患者共享网络，并描述其主要护理提供者的网络特征与临终结局之间的关系；以及(2)阐明内科患者共享网络与痴呆患者临终时接受的护理强度和质量的种族差异之间的关系。随着对医疗质量差异和医生网络之间关系的进一步了解，R03将成为达特茅斯大学未来研究的基础，为健康经济和服务研究的新领域提供信息，并可能提出许多其他问题，涉及医生对医疗质量的影响和阿尔茨海默病患者的使用。

PROJECT SUMMARY Alzheimer’s disease and other related dementias (ADRD) are widely acknowledged as a major cause of morbidity and mortality in older populations. There are racial disparities in prevalence, with older African-Americans being twice as likely as older whites of having ADRD, with more severe symptoms at the time of diagnosis. Treatment intensity of people with ADRD is well documented to differ by race, including differences in health services received such as medication use and end of life care patterns. For example, African-Americans have 1.77 times the risk of having a feeding tube placed at the end of life than white patients. While differences in patient preference across racial and ethnic groups are documented, one major gap in our knowledge is what role physician practice characteristics have on disparities. While disparities could exist because the same physician is treating African-American and white patients differently, an alternative could be that people of different races with ADRD are seen largely by different physicians, with varying experience with either dementia or racial minorities. Furthermore, physicians seeing minority dementia patients may be in completely different physician “networks,” meaning minorities see physicians who have differential connections to providers with specialized ability to diagnose and treat people with dementia. The influence of physician professional connections on behavior can be studied by drawing on methods developed for the study of social networks. Social networks are structural representations of social interactions and personal or professional relationships. For physicians, social networks consist of colleagues with whom they share information, which can be measured by inferring connections when physicians share patients. The goal of this R03 is to develop preliminary data and methods to study the influence of social networks of physicians on disparities in end of life (EOL) care delivered to white and African-American Medicare beneficiaries with ADRD. We propose to address these questions developing social networks of physicians who provide EOL care to dementia patients, stratified by race, and study how these networks are associated with the quality and racial disparities of that care. Thus, this R03 is designed to: (1) construct and summarize physician patient-sharing networks for dementia patients and describe the relationship between network characteristics of their predominant provider of care and end of life outcomes; and (2) elucidate the relationship between physician patient-sharing networks and the disparities by race in intensity and quality of care received at the end of life for dementia patients. With greater understanding of the relationship between disparities in quality of care and physician networks, this R03 will form the basis for future research at Dartmouth to inform new areas of health economic and services research, and potentially many other questions regarding physician influence of healthcare quality and use for people with Alzheimer’s disease.