Jacqueline Bachand1, Pamela R Soulos2,3, Jeph Herrin2,4,5, Craig E Pollack6,7, Xiao Xu2,8, Xiaomei Ma1,2, Cary P Gross9,10. 1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA. 2. Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA. 3. Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, 06520, USA. 4. Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 5. Health Research & Educational Trust, Chicago, IL, USA. 6. Johns Hopkins School of Medicine, Baltimore, MD, USA. 7. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 8. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA. 9. Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA. cary.gross@yale.edu. 10. Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, 06520, USA. cary.gross@yale.edu.
Abstract
PURPOSE: Little is known about how the structure of interdisciplinary groups of physicians affects the timeliness of breast cancer surgery their patients receive. We used social network methods to examine variation in surgical delay across physician peer groups and the association of this delay with group characteristics. METHODS: We used linked Surveillance, Epidemiology, and End Results-Medicare data to construct physician peer groups based on shared breast cancer patients. We used hierarchical generalized linear models to examine the association of three group characteristics, patient racial composition, provider density (the ratio of potential vs. actual connections between physicians), and provider transitivity (clustering of providers within groups), with delayed surgery. RESULTS: The study sample included 8338 women with breast cancer in 157 physician peer groups. Surgical delay varied widely across physician peer groups (interquartile range 28.2-50.0%). For every 10% increase in the percentage of black patients in a peer group, there was a 41% increase in the odds of delayed surgery for women in that peer group regardless of a patient's own race [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73]. Women in physician peer groups with the highest provider density were less likely to receive delayed surgery than those in physician peer groups with the lowest provider density (OR 0.65, 95% CI 0.44-0.98). We did not find an association between provider transitivity and delayed surgery. CONCLUSIONS: The likelihood of surgical delay varied substantially across physician peer groups and was associated with provider density and patient racial composition.
PURPOSE: Little is known about how the structure of interdisciplinary groups of physicians affects the timeliness of breast cancer surgery their patients receive. We used social network methods to examine variation in surgical delay across physician peer groups and the association of this delay with group characteristics. METHODS: We used linked Surveillance, Epidemiology, and End Results-Medicare data to construct physician peer groups based on shared breast cancerpatients. We used hierarchical generalized linear models to examine the association of three group characteristics, patient racial composition, provider density (the ratio of potential vs. actual connections between physicians), and provider transitivity (clustering of providers within groups), with delayed surgery. RESULTS: The study sample included 8338 women with breast cancer in 157 physician peer groups. Surgical delay varied widely across physician peer groups (interquartile range 28.2-50.0%). For every 10% increase in the percentage of black patients in a peer group, there was a 41% increase in the odds of delayed surgery for women in that peer group regardless of a patient's own race [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73]. Women in physician peer groups with the highest provider density were less likely to receive delayed surgery than those in physician peer groups with the lowest provider density (OR 0.65, 95% CI 0.44-0.98). We did not find an association between provider transitivity and delayed surgery. CONCLUSIONS: The likelihood of surgical delay varied substantially across physician peer groups and was associated with provider density and patient racial composition.
Entities:
Keywords:
Breast cancer care; Network density; Network transitivity; Surgery delay
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