Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI

Abstract

BackgroundPerioperative MRI has disseminated into breast cancer practice despite equivocal evidence. We used a novel social network approach to assess the relationship between the characteristics of surgeons’ patient‐sharing networks and subsequent use of MRI.MethodsWe identified a cohort of female patients with stage 0‐III breast cancer from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database. We used claims data from these patients and non‐cancer patients from the 5% Medicare sample to identify peer groups of physicians who shared patients during 2004‐2006 (T1). We used a multivariable hierarchical model to identify peer group characteristics associated with uptake of MRI in T2 (2007‐2009) by surgeons who had not used MRI in T1.ResultsOur T1 sample included 15 149 patients with breast cancer, treated by 2439 surgeons in 390 physician groups. During T1, 9.1% of patients received an MRI; the use of MRI varied from 0% to 100% (IQR 0%, 8.5%) across peer groups. After adjusting for clinical characteristics, patients treated by surgeons in groups with a higher proportion of primary care physicians (PCPs) in T1 were less likely to receive MRI in T2 (OR = 0.81 for 10% increase in PCPs, 95% CI = 0.71, 0.93). Surgeon transitivity (ie, clustering of surgeons) was significantly associated with MRI receipt (P = 0.013); patients whose surgeons were in groups with higher transitivity in T1 were more likely to receive MRI in T2 (OR = 1.29 for 10% increase in clustering, 95% CI = 1.06, 1.58).ConclusionThe characteristics of a surgeon's peer network are associated with their patients’ subsequent receipt of perioperative MRI.

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

“…Research found that PCNs can effectively shape healthcare by acting as a driver for innovation and optimized performance, especially where effective network strengths meet potentially new approaches to care [5]. Also, physician peer networks have emerged as a potentially important factor influencing medical practice [11]. Thus, being part of such a network might support the adoption of specific behaviors.…”

“…As interacting physicians in networks likely share their beliefs, ideas and experiences with each other, the interpersonal information exchange may influence practice patterns [14] and turn peer influence into a potential driver of physicians' practice styles [15]. Studies of communities of practice and physician peer networks have identified differences in care patterns and patient outcomes based on peer connections [15][16][17][18] with regards to therapy uptake [16], or the adoption of technology [15], but have not focused yet in-depth on how physicians might have an impact on each other [11]. The role PCNs might play in supporting rational prescribing and use of antibiotics for non-complicated infections is yet unknown.…”

Promoting rational antibiotic prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

“…As interacting physicians in networks likely share their beliefs, ideas and experiences with each other, the interpersonal information exchange may influence practice patterns [14] and turn peer influence into a potential driver of physicians' practice styles [15]. Studies of communities of practice and physician peer networks have identified differences in care patterns and patient outcomes based on peer connections [15][16][17][18] with regards to therapy uptake [16], or the adoption of technology [15], but have not focused yet in-depth on how physicians might have an impact on each other [11]. The role PCNs might play in supporting rational prescribing and use of antibiotics for non-complicated…”

Promoting rational antibiotics prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

“…Research found that PCN can effectively shape healthcare by acting as a driver for innovation and optimized performance, especially where effective network strengths meet potentially new approaches to care [5]. Also, physician peer networks have emerged as a potentially important factor influencing medical practice [11]. Thus, being part of such a network might support the adoption of specific behaviors.…”

“…As interacting physicians in networks likely share their beliefs, ideas and experiences with each other, the interpersonal information exchange may influence practice patterns [14] and turn peer influence into a potential driver of physicians' practice styles [15]. Studies of communities of practice and physician peer networks have identified differences in care patterns and patient outcomes based on peer connections [15][16][17][18] with regards to therapy uptake [16], or the adoption of technology [15], but have not focused yet in-depth on how physicians might have an impact on each other [11]. The role PCN might play in supporting rational prescribing and use of antibiotics for non-complicated infections is yet unknown.…”