Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Health Serv Res. 2019 Aug;54(4):880-889. doi: 10.1111/1475-6773.13151. Epub 2019 Apr 1.
To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes.
Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011.
We constructed a national cardiovascular disease patient-sharing physician network and used network analysis to characterize physician network centrality with two measures: within-hospital degree centrality (number of connections within a hospital) and across-hospital degree centrality (number of connections across hospitals). The primary outcome was risk-adjusted 2-year case fatality. Hierarchical logistic regression estimated the effects of physician's within-hospital and across-hospital degree centrality on case fatality. We included 105 109 ICD therapy patients and 3474 ICD implanting physicians in our analyses.
After controlling for other physician and hospital characteristics, we observed greater risk-adjusted case fatality among patients treated by physicians in the highest across-hospital degree tertile compared to lowest tertile (OR [95% CI] = 1.10 [1.04-1.16], P = 0.001) and lowest tertile volume physicians compared with highest volume (OR [95% CI] = 0.90 [0.84-0.95], P < 0.001). Physician's within-hospital degree tertile was inversely associated with case fatality but not statistically significant.
Degree centrality measures capture information independent of procedure volume and raise questions about the quality of physicians with networks that predict worse health outcomes.
评估两种新的医生网络中心度衡量指标及其与植入式心脏复律除颤器（ICD）程序量和健康结果的关联。
2007 年至 2011 年的医疗保险索赔和全国心血管数据注册数据。
我们构建了一个全国性的心血管疾病患者共享医生网络，并使用网络分析用两种措施来描述医生网络中心度：院内度中心度（医院内的连接数量）和院外度中心度（医院间的连接数量）。主要结局是风险调整后的 2 年病死率。分层逻辑回归估计了医生的院内和院外度中心度对病死率的影响。我们将 105109 例 ICD 治疗患者和 3474 名 ICD 植入医生纳入分析。
在控制了其他医生和医院特征后，与最低三分位相比，接受处于最高院外度三分位的医生治疗的患者的风险调整病死率更高（比值比[95%置信区间] = 1.10 [1.04-1.16]，P = 0.001），而接受最低三分位容量医生治疗的患者的病死率则更低（比值比[95%置信区间] = 0.90 [0.84-0.95]，P < 0.001）。医生的院内度三分位与病死率呈负相关，但无统计学意义。
中心度衡量指标捕捉到了与程序量无关的信息，并对那些具有预测更差健康结果的网络的医生的质量提出了质疑。
