Physician's peer exposure and the adoption of a new cancer treatment modality

Abstract

Background New technologies—often with limited evidence to support their effectiveness—frequently diffuse into clinical practice and increase the costs of cancer care. We studied whether physician peer exposure was associated with the subsequent adoption of a new approach to adjuvant radiation therapy (brachytherapy) for the treatment of women with early stage breast cancer. Methods We performed a retrospective cohort study using SEER-Medicare data. Data from 2003–2004 was used to classify surgeons as early brachytherapy adopters and, among non-early adopters, whether they shared patients with early adopters (peer exposure). Data from 2005–2006 was used to examine whether women were more likely to receive brachytherapy if their surgeons were exposed to early adopters. Results Overall, the proportion of women receiving brachytherapy increased from 3.2% in 2003–2004 to 4.7% in 2005–2006. In this latter period, 2,087 patients were assigned to 328 non-early adopting surgeons. In unadjusted analyses, patients whose surgeons were connected to early adopters during 2003–2004 were significantly more likely to receive brachytherapy in 2005–2006 compared to those whose surgeons were not connected to early adopters (8.0% versus 4.1%, p=0.003). In adjusted analyses, the predicted probability of receiving brachytherapy in patients whose surgeon did have an early adopting peer was 3.9% vs. 1.0% among those whose surgeons did not have an early adopting peer(p=0.03). Conclusions Exposure to peers who were early adopters of brachytherapy was associated with a surgeon’s subsequent uptake of brachytherapy. This study provides an example of a novel approach to examining the diffusion of innovation in cancer care.

Trends and Predictors of Chemotherapy Use among Thyroid Cancer Patients in the National Cancer Database (2004-2013)

“…Previous studies note earlier adoption of innovative cancer treatments and procedures in specialized cancer centers and vary based on physician-related factors, including the practice of their peers [20,21,22]. We did not observe a significant difference in the use or early adoption of chemotherapy by facility type.…”

An analysis of patient-sharing physician networks and implantable cardioverter defibrillator therapy

“…The application of social network analysis to health care, particularly with respect to its organization, is relatively new among health services researchers (Luke 2007; O'Malley 2013). It has been demonstrated empirically that professional relationships between physicians influence clinical outcomes, including prescribing behavior, diffusion of technology, and quality and cost of care (Barnett et al 2012; Bridewell and Das 2011; Fattore et al 2009; Pollack et al 2015). For example, physician networks with higher density have greater levels of Medicare spending (Barnett et al 2012).…”

An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care

“…Social network analysis has been increasingly used to examine patterns of health care delivery and outcomes . In this context, pairs of physicians who provide care to the same patients have been shown to frequently know and refer to one another .…”

“…The connections between pairs of physicians have been aggregated into larger connected groups of physicians (“peer groups”) which may exhibit similar practice styles, potentially due to social influence, shared context, or other factors . There is growing evidence that physicians in peer groups deliver similar kinds of care, have similar rates of complications following surgery, and follow similar patterns in adoption of new technologies …”