Effects of Physician Social Networks on Surgical Quality, Safety, and Costs

医生社交网络对手术质量、安全性和成本的影响

• 批准号: 8919962
• 负责人: John Malcolm Hollingsworth
• 金额: $ 15.51万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8919962
• 关键词: Effects; Physician; Social; Networks; Surgical

DESCRIPTION (provided by applicant): Substantial variation in surgical mortality rates and costs per surgical episode exists across providers, suggesting opportunities for improvement. While a variety of initiatives have been launched to enhance the safety, quality, and cost-efficiency of surgical care, these efforts focus almost exclusively on the surgeon's activities in the operating room and immediately afterward. However, there is growing recognition that coordination of care and communication among the surgeon, the referring primary care physician (PCP), and consultants are crucial. As such, optimizing surgical care will require the ability to measure and understand the care delivered by all physicians involved in the surgical episode and their interactions. In this context, the candidate (Dr. John M. Hollingsworth) seeks to characterize and evaluate the effectiveness of physician social networks that deliver surgical care. The candidate, a urologist and health services researcher at the University of Michigan, will leverage this proposal to broaden the scientific and clinical scope of his research agenda, and to facilitate his development into an independent investigator. During the period of support, he will pursue additional didactic instruction in several disciplines, including graduate- and doctoral-level courses in network theory, health economics, and healthcare organization and policy. He will also have ample opportunities for mentored, project-based learning, including the hands-on application of advanced statistical modeling and the techniques of social network analysis. The research plan has 3 Specific Aims. Specific Aim 1: To map physician social networks that deliver surgical care. With files from Blue Cross Blue Shield of Michigan and Michigan Medicare plans (2008-2010), the candidate will identify beneficiaries undergoing 1 of 4 common inpatient surgical procedures. By surgery type, he will use a validated method to graph physician social networks at hospitals where these procedures are performed, characterizing them in a number of directions across a range of local and global network properties. He hypothesizes that, compared with physician social networks serving rural areas, those at urban hospitals have a larger number of physicians, but their average distances are similar. He posits that physician social networks that care for female and black patients will be sparser than those for male and white patients, respectively. Specific Aim 2: To evaluate the effect of physician social networks on surgical care safety and quality. The candidate will then examine the association between physician connectedness and a hospital's safety culture/teamwork climate. He will also assess for a relationship between measures of surgical quality (i.e., operative mortality, readmissions, and postoperative complications) and local network properties across 3 phases of the surgical episode. He hypothesizes that networks in which the surgeon, referring PCP, and consultant tend to cluster together foster environments of safety. He posits that while surgeon centrality confers lower morbidity and mortality during the operative phase, greater surgeon-PCP tie strength leads to fewer complications and readmissions in the transition phase. Specific Aim 3: To examine the impact of physician social networks on the costs of surgical care. Finally, the candidate will quantify total expenditures for patients cared for by networks with varying levels of physician connectedness. He will explore specific sources of savings by comparing component payments over global network properties. He hypothesizes that significant variation in total episode expenditures exists between networks. He posits that cohesive and dense networks accrue savings from a variety of sources, including lower payments for post-acute care. Completion of the proposed research will inform the Centers for Medicare and Medicaid Services and other large payers on the extent to which strengthening interactions between physicians, in general, might impact on the safety, quality, and costs of surgical care. More broadly, findings from this proposal will provide researchers, clinician leaders, and policymakers with additional insight into the nature of relationships among different types of physicians and their importance for healthcare delivery.

描述（由申请人提供）：各提供者之间的手术死亡率和每次手术费用存在显着差异，表明有改进的机会。虽然已经发起了各种举措来提高手术护理的安全性、质量和成本效益，但这些努力几乎完全集中于外科医生在手术室和手术后的活动。然而，人们越来越认识到，外科医生、转诊初级保健医生 (PCP) 和顾问之间的护理协调和沟通至关重要。因此，优化手术护理需要能够衡量和理解参与手术的所有医生提供的护理及其相互作用。在这种背景下，候选人（约翰·M·霍林斯沃思博士）试图描述和评估提供外科护理的医生社交网络的有效性。该候选人是密歇根大学的泌尿科医生和健康服务研究员，他将利用这一提案来扩大其研究议程的科学和临床范围，并促进他发展成为一名独立研究者。在支持期间，他将在多个学科中进行额外的教学指导，包括网络理论、卫生经济学以及医疗保健组织和政策方面的研究生和博士课程。他还将有充足的机会进行指导性的、基于项目的学习，包括先进统计模型和社交网络分析技术的实践应用。该研究计划有 3 个具体目标。具体目标 1：绘制提供外科护理的医生社交网络地图。借助密歇根州 Blue Cross Blue Shield 和密歇根州医疗保险计划（2008-2010 年）的文件，候选人将确定接受 4 种常见住院外科手术中的 1 种的受益人。根据手术类型，他将使用经过验证的方法来绘制执行这些手术的医院的医生社交网络图，并在一系列本地和全球网络属性的多个方向上表征它们。他假设，与服务农村地区的医生社交网络相比，城市医院的医生数量更多，但平均距离相似。他认为，照顾女性和黑人患者的医生社交网络将分别比照顾男性和白人患者的医生社交网络更少。具体目标 2：评估医生社交网络对手术护理安全和质量的影响。然后，候选人将检查医生的联系与医院的安全文化/团队合作氛围之间的关联。他还将评估手术质量指标（即手术死亡率、再入院和术后并发症）与手术过程三个阶段的本地网络特性之间的关系。他假设外科医生、转诊 PCP 和顾问聚集在一起的网络往往会营造安全的环境。他认为，虽然外科医生的中心地位可以降低手术阶段的发病率和死亡率，但更大的外科医生与 PCP 的联系强度可以减少过渡阶段的并发症和再入院。具体目标 3：研究医生社交网络对手术护理成本的影响。最后，候选人将量化具有不同医生连接水平的网络所护理的患者的总支出。他将通过比较全球网络资产的组成部分支付来探索具体的节省来源。他假设网络之间的总剧集支出存在显着差异。他认为，有凝聚力和密集的网络可以从多种来源节省开支，包括降低急性期后护理的费用。拟议研究的完成将告知医疗保险和医疗补助服务中心以及其他大型付款人，一般来说，加强医生之间的互动可能会在多大程度上影响手术护理的安全、质量和成本。更广泛地说，该提案的研究结果将为研究人员、临床医生领导者和政策制定者提供更多关于不同类型医生之间关系的性质及其对医疗保健服务的重要性的见解。

项目成果

Urologists and the patient centered medical home.

泌尿科医生和以患者为中心的医疗之家。

• DOI: 10.1016/j.juro.2013.03.119
• 发表时间: 2013
• 期刊: The Journal of urology
• 作者: Sakshaug,JosephW;Miller,DavidC;Hollenbeck,BrentK;Wei,JohnT;Hollingsworth,JohnM
• 通讯作者: Hollingsworth,JohnM

Underuse of 24-Hour Urine Collection Among Children With Incident Urinary Stones: A Quality-of-care Concern?

• DOI: 10.1016/j.urology.2014.04.035
• 发表时间: 2014-08-01
• 期刊: UROLOGY
• 影响因子: 2.1
• 作者: Ellison, Jonathan S.;Kaufman, Samuel R.;Hollingsworth, John M.
• 通讯作者: Hollingsworth, John M.

Lower urinary tract symptoms in men.

• DOI: 10.1136/bmj.g4474
• 发表时间: 2014-08-14
• 期刊: BMJ (Clinical research ed.)
• 作者: Hollingsworth JM;Wilt TJ
• 通讯作者: Wilt TJ

Statin Use and Risk of Sepsis After Percutaneous Nephrolithotomy.

他汀类药物的使用和经皮肾镜取石术后败血症的风险。

• DOI: 10.1089/end.2015.0042
• 发表时间: 2015
• 期刊: Journal of endourology
• 影响因子: 2.7
• 作者: Alruwaily,AbdulrahmanF;Eisner,BrianH;Bierlein,MaggieJ;Ghani,KhurshidR;WolfJr,JStuart;Hollenbeck,BrentK;Hollingsworth,JohnM
• 通讯作者: Hollingsworth,JohnM