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Matthews LJ, Damberg CL, Zhang S, Escarce JJ, Gibson CB, Schuler M, Popescu I. Within-Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease. J Am Heart Assoc 2023; 12:e030653. [PMID: 37982233 PMCID: PMC10727292 DOI: 10.1161/jaha.123.030653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Black-White disparities in heart disease treatment may be attributable to differences in physician referral networks. We mapped physician networks for Medicare patients and examined within-physician Black-White differences in patient sharing between primary care physicians and cardiologists. METHODS AND RESULTS Using Medicare fee-for-service files for 2016 to 2017, we identified a cohort of Black and White patients with heart disease and the primary care physicians and cardiologists treating them. To ensure the robustness of within-physician comparisons, we restricted the sample to regional health care markets (ie, hospital referral regions) with at least 10 physicians sharing ≥3 Black and White patients. We used claims to construct 2 race-specific physician network measures: degree (number of cardiologists with whom a primary care physician shares patients) and transitivity (network tightness). Measures were adjusted for Black-White differences in physician panel size and calculated for all settings (hospital and office) and for office settings only. Of 306 US hospital referral regions, 226 and 145 met study criteria for all settings and office setting analyses, respectively. Black patients had more cardiology encounters overall (6.9 versus 6.6; P<0.001) and with unique cardiologists (3.0 versus 2.6; P<0.001), but fewer office encounters (31.7% versus 41.1%; P<0.001). Primary care physicians shared Black patients with more cardiologists than White patients (mean differential degree 23.4 for all settings and 3.6 for office analyses; P<0.001 for both). Black patient-sharing networks were less tightly connected in all but office settings (mean differential transitivity -0.2 for all settings [P<0.001] and near 0 for office analyses [P=0.74]). CONCLUSIONS Within-physician Black-White differences in patient sharing exist and may contribute to disparities in cardiac care.
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Affiliation(s)
| | | | | | | | | | | | - Ioana Popescu
- RAND CorporationSanta MonicaCA
- David Geffen School of Medicine at UCLALos AngelesCA
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2
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Pope E, Sehgal N. The Role of Physician Networks and Receipt of Opioid-Related Payments. J Gen Intern Med 2023; 38:1812-1820. [PMID: 36376628 PMCID: PMC10272029 DOI: 10.1007/s11606-022-07870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid-related promotional payments are associated with increased prescribing of the promoted drug, but little is known about whether physicians receiving payments influence peers to accept similar payments. OBJECTIVE We examine the association of physician network-level position among peers and the acceptance of opioid-related promotional payments using national publicly available datasets from 2015. Design National cross-sectional data from the Centers for Medicare and Medicaid Services (CMS) National Downloadable File and Open Payment data. SUBJECTS Physicians who shared Medicare patients with at least two other physicians in 2015. MAIN MEASURES Modified Poisson's regressions are used to estimate the adjusted incidence rate ratio (aIRR) for social network position (i.e., degree, betweenness, and transitivity) and number of peers with payments as a function of individual receipt of opioid-related promotional payment and among those with payments, those who have five or more payments, and those who have $100 or more in payments. KEY RESULTS Physicians with opioid-related payments were significantly more likely to have at least one peer with an opioid-related payment (IRR: 2.5, 95% CI: 2.3-2.8), but had fewer shared patients (i.e., top quartile compared to the first quartile for degree centrality: 0.4, 95% CI: 0.3-0.4) and belonged to less cohesive networks (i.e., top quartile compared to the first quartile for betweenness centrality: 0.9, 95% CI: 0.8-0.9). CONCLUSIONS Our study demonstrates that physicians receiving opioid-related payments are more likely to cluster within physician networks.
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Affiliation(s)
- Elle Pope
- University of Maryland School of Public Health, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA.
| | - Neil Sehgal
- University of Maryland School of Public Health, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA
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3
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Schiaffino MK, Murphy JD, Nalawade V, Nguyen P, Shakya H. Association of Physician Referrals with Timely Cancer Care Using Tumor Registry and Claims Data. Health Equity 2022; 6:106-115. [PMID: 35261937 PMCID: PMC8896170 DOI: 10.1089/heq.2021.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
More Americans are being screened for and more are surviving colorectal cancer due to advanced treatments and better quality of care; however, these benefits are not equitably distributed among diverse or older populations. Differential care delivery outcomes are driven by multiple factors, including access to timely treatment that comes from high-quality care coordination. Providers help ensure such coordinated care, which includes timely referrals to specialists. Variation in referrals between providers can also result in differences in treatment plans and outcomes. Patients who are more often referred between the same diagnosing and treating providers may benefit from more timely care compared to those who are not. Our objective is to examine patterns of referral, or patient-sharing networks (PSNs), and our outcome, treatment delay of 30-days (yes/no). We hypothesize that if a patient is in a PSN they will have lower odds of a 30-day treatment initiation delay. Our observational population-based analysis using the National Cancer Institute (NCI)-linked tumor registry and Medicare claims database includes records for 27,689 patients diagnosed with colorectal cancer from 2001 to 2013, and treated with either chemotherapy, radiotherapy, or surgery. We modeled the adjusted odds of a delay and found 17.04% of patients experienced a 30-day delay in initial treatment. Factors that increased odds of a delay were lack of membership in a PSN (adjusted odds ratio [AOR]: 2.20; 95% confidence interval [CI]: 1.71-2.84), racial/ethnic minority status, and having multiple comorbidities. Provider characteristics significantly associated with greater odds of a delay were if dyads were not in the same facility (AOR: 1.95; 95% CI: 1.81-2.10), if providers were different genders, most notably male (diagnosing) and female (treating) [AOR: 1.23; 95% CI: 1.08-1.40, p = 0.0015]. PSNs appear to be associated with reduced of a care delay. The associations observed in our study address the demand for developing multilevel interventions to improve the delivery and coordination of high-quality of care for older cancer patients.
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Affiliation(s)
- Melody K. Schiaffino
- Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
| | - James D. Murphy
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, and University of California San Diego, La Jolla, California, USA
| | - Vinit Nalawade
- Center for Health Equity, Education, and Research (CHEER), University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, and University of California San Diego, La Jolla, California, USA
| | - Phuong Nguyen
- Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
| | - Holly Shakya
- Division of Global Health, University of California San Diego, La Jolla, California, USA
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4
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Dossa F, Zeltzer D, Sutradhar R, Simpson AN, Baxter NN. Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons. JAMA Surg 2021; 157:95-103. [PMID: 34757424 DOI: 10.1001/jamasurg.2021.5784] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Studies have found that female surgeons have fewer opportunities to perform highly remunerated operations, a circumstance that contributes to the sex-based pay gap in surgery. Procedures performed by surgeons are, in part, determined by the referrals they receive. In the US and Canada, most practicing physicians who provide referrals are men. Whether there are sex-based differences in surgical referrals is unknown. Objective To examine whether physicians' referrals to surgeons are influenced by the sex of the referring physician and/or surgeon. Design, Setting, and Participants This cross-sectional, population-based study used administrative databases to identify outpatient referrals to surgeons in Ontario, Canada, from January 1, 1997, to December 31, 2016, with follow-up to December 31, 2018. Data analysis was performed from April 7, 2019, to May 14, 2021. Exposures Referring physician sex. Main Outcomes and Measures This study compared the proportion of referrals (overall and those referrals that led to surgery) made by male and female physicians to male and female surgeons to assess associations between surgeon, referring physician, or patient characteristics and referral decisions. Discrete choice modeling was used to examine the extent to which sex differences in referrals were associated with physicians' preferences for same-sex surgeons. Results A total of 39 710 784 referrals were made by 44 893 physicians (27 792 [61.9%] male) to 5660 surgeons (4389 [77.5%] male). Female patients made up a greater proportion of referrals to female surgeons than to male surgeons (76.8% vs 55.3%, P < .001). Male surgeons accounted for 77.5% of all surgeons but received 87.1% of referrals from male physicians and 79.3% of referrals from female physicians. Female surgeons less commonly received procedural referrals than male surgeons (25.4% vs 33.0%, P < .001). After adjusting for patient and referring physician characteristics, male physicians referred a greater proportion of patients to male surgeons than did female physicians; differences were greatest among referrals from other surgeons (rate ratio, 1.14; 95% CI, 1.13-1.16). Female physicians had a 1.6% (95% CI, 1.4%-1.9%) greater odds of same-sex referrals, whereas male physicians had a 32.0% (95% CI, 31.8%-32.2%) greater odds of same-sex referrals; differences did not attenuate over time. Conclusions and Relevance In this cross-sectional, population-based study, male physicians appeared to have referral preferences for male surgeons; this disparity is not narrowing over time or as more women enter surgery. Such preferences lead to lower volumes of and fewer operative referrals to female surgeons and are associated with sex-based inequities in medicine.
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Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dan Zeltzer
- Berglas School of Economics, Tel Aviv University, Tel Aviv, Israel.,Institute of Labor Economics, Bonn, Germany
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Division of Minimally Invasive Gynecologic Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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5
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Zhang V(S, King MD. Tie Decay and Dissolution: Contentious Prescribing Practices in the Prescription Drug Epidemic. ORGANIZATION SCIENCE 2021; 32:1149-1173. [DOI: 10.1287/orsc.2020.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although a substantial body of work has investigated drivers of tie formation, there is growing interest in understanding why relationships decay or dissolve altogether. The networks literature has tended to conceptualize tie decay as driven by processes similar to those underlying tie formation. Yet information that is revealed through ongoing interactions can exert different effects on tie formation and tie decay. This paper investigates how tie decay and tie formation processes differ by focusing on contentious practices. To the extent that information about dissimilarities in contentious practices is learned through ongoing interactions, it can exert diverging effects on tie formation and tie decay. Using a longitudinal data set of 141,543 physician dyads, we find that differences in contentious prescribing led ties to weaken or dissolve altogether but did not affect tie formation. The more contentious the practice and the more information available about the practice, the stronger the effect on tie decay and dissolution. Collectively, these findings contribute to a more nuanced understanding of relationship evolution as an unfolding process through which deeper-level differences are revealed and shape the outcome of the tie.
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Affiliation(s)
| | - Marissa D. King
- Yale School of Management, Yale University, New Haven, Connecticut 06511
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6
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Goyal R, De Gruttola V. Investigation of patient-sharing networks using a Bayesian network model selection approach for congruence class models. Stat Med 2021; 40:3167-3180. [PMID: 33811360 PMCID: PMC8207989 DOI: 10.1002/sim.8969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/08/2022]
Abstract
A Bayesian approach to conduct network model selection is presented for a general class of network models referred to as the congruence class models (CCMs). CCMs form a broad class that includes as special cases several common network models, such as the Erdős-Rényi-Gilbert model, stochastic block model, and many exponential random graph models. Due to the range of models that can be specified as CCMs, our proposed method is better able to select models consistent with generative mechanisms associated with observed networks than are current approaches. In addition, our approach allows for incorporation of prior information. We illustrate the use of this approach to select among several different proposed mechanisms for the structure of patient-sharing networks; such networks have been found to be associated with the cost and quality of medical care. We found evidence in support of heterogeneity in sociality but not selective mixing by provider type or degree.
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Affiliation(s)
- Ravi Goyal
- Health Unit, Mathematica, Princeton, New Jersey, USA
| | - Victor De Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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7
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Geissler KH, Lubin B, Ericson KMM. The association of insurance plan characteristics with physician patient-sharing network structure. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2021; 21:189-201. [PMID: 33635494 PMCID: PMC8192486 DOI: 10.1007/s10754-021-09296-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
Professional and social connections among physicians impact patient outcomes, but little is known about how characteristics of insurance plans are associated with physician patient-sharing network structure. We use information from commercially insured enrollees in the 2011 Massachusetts All Payer Claims Database to construct and examine the structure of the physician patient-sharing network using standard and novel social network measures. Using regression analysis, we examine the association of physician patient-sharing network measures with an indicator of whether a patient is enrolled in a health maintenance organization (HMO) or preferred provider organization (PPO), controlling for patient and insurer characteristics and observed health status. We find patients enrolled in HMOs see physicians who are more central and densely embedded in the patient-sharing network. We find HMO patients see PCPs who refer to specialists who are less globally central, even as these specialists are more locally central. Our analysis shows there are small but significant differences in physician patient-sharing network as experienced by patients with HMO versus PPO insurance. Understanding connections between physicians is essential and, similar to previous findings, our results suggest policy choices in the insurance and delivery system that change physician connectivity may have important implications for healthcare delivery, utilization and costs.
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Affiliation(s)
- Kimberley H Geissler
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Mailing Address: 715 North Pleasant Street, 337 Arnold House, Amherst, MA, 01003, USA.
| | - Benjamin Lubin
- Information Systems Department, Questrom School of Business, Boston University, Mailing Address: 595 Commonwealth Avenue, Room 621A, Boston, MA, 02215, USA
| | - Keith M Marzilli Ericson
- Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Rafik B. Hariri Building, 595 Commonwealth Avenue, Boston, MA, 02215, USA
- National Bureau of Economic Research, Cambridge, MA, 02138, USA
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8
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Geissler KH, Lubin B, Ericson KMM. The association between patient sharing network structure and healthcare costs. PLoS One 2020; 15:e0234990. [PMID: 32569294 PMCID: PMC7307780 DOI: 10.1371/journal.pone.0234990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
STUDY QUESTION While physician relationships (measured through shared patients) are associated with clinical and utilization outcomes, the extent to which this is driven by local or global network characteristics is not well established. The objective of this research is to examine the association between local and global network statistics with total medical spending and utilization. DATA SOURCE Data used are the 2011 Massachusetts All Payer Claims Database. STUDY DESIGN The association between network statistics and total medical spending and utilization (using standardized prices) is estimated using multivariate regression analysis controlling for patient demographics and health status. DATA COLLECTION We limit the sample to continuously enrolled commercially insured patients in Massachusetts in 2011. PRINCIPAL FINDINGS Mean patient age was 45 years, and 56.3% of patients were female. 73.4% were covered by a health maintenance organization. Average number of visits was 5.43, with average total medical spending of $4,911 and total medical utilization of $4,252. Spending was lower for patients treated by physicians with higher degree (p<0.001), eigenvector centrality (p<0.001), clustering coefficient (p<0.001), and measures reflecting the normalized degree (p<0.001) and eigenvector centrality (p<0.001) of specialists connected to a patient's PCP. Spending was higher for patients treated by physicians with higher normalized degree, which accounts for physician specialty and patient panel size (p<0.001). Results were similar for utilization outcomes, although magnitudes differed indicating patients may see different priced physicians. CONCLUSIONS Generally, higher values of network statistics reflecting local connectivity adjusted for physician characteristics are associated with increased costs and utilization, while higher values of network statistics reflecting global connectivity are associated with decreased costs and utilization. As changes in the financing and delivery system advance through policy changes and healthcare consolidation, future research should examine mechanisms through which this structure impacts outcomes and potential policy responses to determine ways to reduce costs while maintaining quality and coordination of care. WHAT THIS STUDY ADDS It is unknown whether local and global measures of physician network connectivity associated with spending and utilization for commercially insured patients?In this social network analysis, we found generally higher values of network statistics reflecting local connectivity are associated with increased costs and utilization, while higher values of network statistics reflecting global connectivity are associated with decreased costs and utilization.Understanding how to influence local and global physician network characteristics may be important for reducing costs while maintaining quality.
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Affiliation(s)
- Kimberley H. Geissler
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Benjamin Lubin
- Information Systems, Boston University Questrom School of Business, Boston, MA, United States of America
| | - Keith M. Marzilli Ericson
- Information Systems, Boston University Questrom School of Business, Boston, MA, United States of America
- Gehr Center for Health Systems Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
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9
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Onnela JP, O’Malley AJ, Keating NL, Landon BE. Comparison of physician networks constructed from thresholded ties versus shared clinical episodes. APPLIED NETWORK SCIENCE 2018; 3:28. [PMID: 30839809 PMCID: PMC6214299 DOI: 10.1007/s41109-018-0084-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare standard methods for constructing physician networks from patient-physician encounter data with a new method based on clinical episodes of care. DATA SOURCE We used data on 100% of traditional Medicare beneficiaries from 51 nationally representative geographical regions for the years 2005-2010. STUDY DESIGN We constructed networks of physicians based on their shared patients. In the fixed-threshold networks and adaptive-threshold networks, we included data on all patient-physician encounters to form the physician-physician ties, and then subsequently thresholded some proportion of the strongest ties. In contrast, in the episode-based approach, only those patient-physician encounters that occurred within shared clinical episodes treating specific conditions contributed towards physician-physician ties. DATA COLLECTION/EXTRACTION METHODS We extracted clinical episodes in the Medicare data and investigated structural properties of the patient-sharing networks of physicians, temporal dynamics of their ties, and temporal stability of network communities across the two approaches. PRINCIPAL FINDINGS The episode-based networks accentuated ties between primary care physicians (PCPs) and medical specialists, had ties that were more likely to reappear in the future, and appeared to have more fluid community structure. CONCLUSIONS Constructing physician networks around shared episodes of care is a clinically sound alternative to previous approaches to network construction that does not require arbitrary decisions about thresholding. The resulting networks capture somewhat different aspects of patient-physician encounters.
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Affiliation(s)
- Jukka-Pekka Onnela
- Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Avenue, Boston, MA USA
| | - A. James O’Malley
- Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
- Division of Primary Care and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
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10
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DuGoff EH, Fernandes-Taylor S, Weissman GE, Huntley JH, Pollack CE. A scoping review of patient-sharing network studies using administrative data. Transl Behav Med 2018; 8:598-625. [PMID: 30016521 PMCID: PMC6086089 DOI: 10.1093/tbm/ibx015] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There is a robust literature examining social networks and health, which draws on the network traditions in sociology and statistics. However, the application of social network approaches to understand the organization of health care is less well understood. The objective of this work was to examine approaches to conceptualizing, measuring, and analyzing provider patient-sharing networks. These networks are constructed using administrative data in which pairs of physicians are considered connected if they both deliver care to the same patient. A scoping review of English language peer-reviewed articles in PubMed and Embase was conducted from inception to June 2017. Two reviewers evaluated article eligibility based upon inclusion criteria and abstracted relevant data into a database. The literature search identified 10,855 titles, of which 63 full-text articles were examined. Nine additional papers identified by reviewing article references and authors were examined. Of the 49 papers that met criteria for study inclusion, 39 used a cross-sectional study design, 6 used a cohort design, and 4 were longitudinal. We found that studies most commonly theorized that networks reflected aspects of collaboration or coordination. Less commonly, studies drew on the strength of weak ties or diffusion of innovation frameworks. A total of 180 social network measures were used to describe the networks of individual providers, provider pairs and triads, the network as a whole, and patients. The literature on patient-sharing relationships between providers is marked by a diversity of measures and approaches. We highlight key considerations in network identification including the definition of network ties, setting geographic boundaries, and identifying clusters of providers, and discuss gaps for future study.
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Affiliation(s)
- Eva H DuGoff
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD, USA
| | - Sara Fernandes-Taylor
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Gary E Weissman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Pulmonary, Allergy, and Critical Care Division, Philadelphia, PA, USA
| | - Joseph H Huntley
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig Evan Pollack
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Geissler KH, Lubin B, Ericson KMM. The Role of Organizational Affiliations in Physician Patient-Sharing Relationships. Med Care Res Rev 2018; 77:165-175. [PMID: 29676190 DOI: 10.1177/1077558718769403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Provider consolidation may enable improved care coordination, but raises concerns about lack of competition. Physician patient-sharing relationships play a key role in constructing patient care teams, but it is unknown how organization affiliations affect these. We use the Massachusetts All Payer Claims Database to examine whether patient-sharing relationships are associated with sharing a practice site, medical group, and/or physician contracting network. Physicians were 17 percentage points more likely to have a patient-sharing relationship if they shared a practice site and 4 percentage points more likely if they shared a medical group, as compared with sharing no affiliation. However, there was no detectable increased probability of a patient-sharing relationship within the same physician contracting network. Our finding that physician patient-sharing relationships are concentrated within organizational boundaries at practice site and medical group levels helps illuminate referral incentives and provide insight into the role of organizational affiliations in patient care team construction.
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