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）：提供者之间存在手术死亡率和每次手术发作成本的实质性差异，这表明有改善的机会。尽管已经发起了各种计划，以提高外科手术护理的安全性，质量和成本效益，但这些努力几乎完全集中在手术室中外科医生的活动上。但是，人们越来越认识到，外科医生，参考初级保健医师（PCP）和顾问之间对护理和沟通的协调至关重要。因此，优化手术护理将需要能够测量和理解所有参与手术事件及其相互作用的医生提供的护理。在这种情况下，候选人（John M. Hollingsworth博士）试图表征和评估提供手术护理的医师社交网络的有效性。候选人是密歇根大学的泌尿科医生和卫生服务研究员，将利用这一建议来扩大其研究议程的科学和临床范围，并促进他的发展成为独立的研究者。在支持期间，他将在几个学科中进行其他教学，包括网络理论，健康经济学以及医疗保健组织和政策的研究生和博士课程。他还将有足够的机会进行基于项目的指导，包括先进统计建模的动手应用和社交网络分析的技术。研究计划具有3个具体目标。特定目的1：绘制提供手术护理的医师社交网络。通过密歇根州蓝十字蓝盾和密歇根州医疗保险计划（2008-2010）的文件，候选人将确定受益人接受4个常见的住院外科手术程序中的1个。根据手术类型，他将使用经过验证的方法在医院进行这些程序进行绘制医师社交网络，并在各种本地和全球网络属性的多个方向上表征它们。他假设，与为农村地区提供服务的医师社交网络相比，城市医院的医生有更多的医生，但它们的平均距离相似。他认为，照顾女性和黑人患者的医师社交网络将比男性和白人患者更稀少。具体目标2：评估医师社交网络对手术护理安全和质量的影响。然后，候选人将检查医师联系与医院的安全文化/团队合作气氛之间的关联。他还将评估手术质量（即手术死亡率，再入院和术后并发症）与手术发作3阶段之间的局部网络特性之间的关系。他假设外科医生，推荐PCP和顾问倾向于聚集在一起的网络促进安全环境。他认为，尽管外科医生的中心性赋予手术阶段的发病率和死亡率较低，但在过渡阶段，较高的外科医生PCP TIE强度会导致更少的并发症和再入院。特定目的3：检查医师社交网络对手术护理成本的影响。最后，候选人将量化由医师联系水平不同的网络所照顾的患者的总支出。他将通过比较全球网络属性的组件付款来探索特定的节省来源。他假设网络之间存在总发作支​​出的显着差异。他认为，从各种来源获得了凝聚力和密集的网络，包括急性后护理的付款较低。拟议研究的完成将为医疗保险和医疗补助服务中心和其他大型付款人提供通知，从而加强医生之间的相互作用的程度可能会影响外科手术护理的安全，质量和成本。更广泛地说，该提案的发现将为研究人员，临床医生和决策者提供对不同类型医生之间关系性质的更多洞察力及其对医疗保健提供的重要性。

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