A Network Analytic Approach to Modeling Variation in Prostate Cancer Care

前列腺癌护理变异建模的网络分析方法

• 批准号: 8468924
• 负责人: Craig Evan Pollack
• 金额: $ 15.66万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8468924
• 关键词: Affect; Appointment; Attitude; Award; Behavior; Cancer Control; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical; Clinical Management; Collection; Comprehensive Cancer Center; Data; Diagnosis; Diffusion; Disease; Epidemiology; Ethnic Origin; Exhibits; Face; Funding; Geographic Locations; Goals; Grant; Health Services; Health Services Research; Health behavior; Individual; Internal Medicine; Intervention; Joints; Knowledge; Link; Malignant Neoplasms; Malignant neoplasm of prostate; Maps; Measures; Mediating; Medicare; Medicare claim; Mentors; Methods; Modeling; Outcome; Pathway Analysis; Patient Care; Patients; Pattern; Patterns of Care; Physicians; Positioning Attribute; Primary Care Physician; Process; Provider; Quality of Care; Race; Radiation Oncologist; Radiation therapy; Research Methodology; Research Personnel; Resources; Sampling; Social Network; Source; Specialist; Structure; Subgroup; Surveys; Techniques; Time; Training; United States; Urologic Cancer; Urologist; Variant; Work; anticancer research; base; cancer care; cancer diagnosis; cancer health disparity; cancer prevention; cancer therapy; effective intervention; follow-up; health disparity; improved; medical schools; men; older men; professor; racial difference; screening; socioeconomics; theories; working group; Affect; Appointment; Attitude; Award; Behavior; Cancer Control; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical; Clinical Management; Collection; Comprehensive Cancer Center; Data; Diagnosis; Diffusion; Disease; Epidemiology; Ethnic Origin; Exhibits; Face; Funding; Geographic Locations; Goals; Grant; Health Services; Health Services Research; Health behavior; Individual; Internal Medicine; Intervention; Joints; Knowledge; Link; Malignant Neoplasms; Malignant neoplasm of prostate; Maps; Measures; Mediating; Medicare; Medicare claim; Mentors; Methods; Modeling; Outcome; Pathway Analysis; Patient Care; Patients; Pattern; Patterns of Care; Physicians; Positioning Attribute; Primary Care Physician; Process; Provider; Quality of Care; Race; Radiation Oncologist; Radiation therapy; Research Methodology; Research Personnel; Resources; Sampling; Social Network; Source; Specialist; Structure; Subgroup; Surveys; Techniques; Time; Training; United States; Urologic Cancer; Urologist; Variant; Work; anticancer research; base; cancer care; cancer diagnosis; cancer health disparity; cancer prevention; cancer therapy; effective intervention; follow-up; health disparity; improved; medical schools; men; older men; professor; racial difference; screening; socioeconomics; theories; working group

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.

描述（由申请人提供）：前列腺癌临床管理中无法解释的变化被认为是癌症治疗中的重要问题。为了研究这种变化的潜在解释，拟议的项目使用社交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：他们在各个临床场所和不同时间看到了多个医生的筛查，诊断，治疗和随访。每个医师不仅有助于护理患者接受的类型和质量，而且地理区域内的医生之间的关系也可能是护理的重要且可修改的决定因素。这项研究的具体目的是：（1）绘制PCP，泌尿科医生和辐射肿瘤学家之间的联系作为网络，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黑人和白人之间观察到的前列腺癌治疗的差异； （3）通过对PCP的转诊决策进行调查来调查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PCP的调查。先生医疗保险样本由1995 - 2005年诊断为局部前列腺癌的男性及其相关的PCP和专家提供商组成。专家在癌症护理网络中的位置将定量确定，并且该职位将与患者级别的癌症护理类型和质量以及护理种族差异有关。 PCP的调查将阐明其转诊决策中重要的因素。理解观察到的变化可能表明可以利用网络结构来提高癌症护理的质量并减少结果的差异。候选人Craig Pollack，医学博士，MHS是Johns Hopkins医学院通用内科医学司的助理教授，并在Sidney Kimmel综合癌症中心的流行病学和会员部联合任命。他的长期目标是成为癌症控制领域的独立，赠款资助的卫生服务研究员。他的短期目标是在癌症预防和控制，网络分析，高级卫生服务研究方法以及组织理论和提供者行为方面发展专业知识。 Pollack博士组建了一个指导团队，其中包括癌症研究，泌尿科癌症，健康差异和网络分析的国家领导者。拟议的项目为Pollack博士提供了培训，指导和资源，以成为致力于改善癌症护理的独立研究者。