College of Health Solutions, Arizona State University, Phoenix, Arizona, USA.
Health Serv Res. 2021 Oct;56(5):908-918. doi: 10.1111/1475-6773.13628. Epub 2021 Feb 4.
To estimate novel measures of generalist physicians' network connectedness to HIV specialists and their associations with two dimensions of HIV quality of care.
Medicare and Medicaid claims and the American Medical Association Masterfile data on people living with HIV (PLWH) and the physicians providing their HIV care in California between 2007 and 2010.
I construct regional patient-sharing physician networks from the shared treatment of PLWH and calculate (a) measures of network connectedness to all physician types and (b) specialty-weighted measures to describe connectedness to HIV specialists. Two HIV quality of care outcomes are then evaluated: medication quality (prescribing antiretroviral drugs from at least two drug classes) and monitoring quality (at least two annual HIV virus monitoring scans). Linear probability models estimate the associations between network statistics and the two dimensions of HIV quality of care, and a policy simulation demonstrates the importance of these statistical relationships. These analyses include 16 124 PLWH, 3240 generalists, and 1031 HIV specialists.
DATA COLLECTION/EXTRACTION METHODS: PLWH are identified from claims for patients with any indication of HIV using an existing algorithm from the literature.
Generalists' network connectedness to HIV specialists is positively related with their own HIV medication quality; one additional HIV specialist connection is associated with a 1.46 percentage point (SE 0.42, P < .01) increase in generalist's medication quality. Based on the estimated associations, a simulated policy that increases connectedness between generalists and HIV specialists reduces the annual rate of HIV infections by up to 6%, roughly 290 fewer infections per year. Only network connectedness to all physician types is associated with improved monitoring quality.
Network connectedness to HIV specialists is positively associated with generalists' HIV medication quality, which suggests that specialists provide clinical support through patient-sharing for complex treatment protocol.
评估普通科医生与艾滋病专家网络联系的新指标，并将其与艾滋病护理质量的两个维度相关联。
2007 年至 2010 年间加利福尼亚州艾滋病毒感染者（PLWH）及其提供艾滋病护理的医生的医疗保险和医疗补助索赔以及美国医学协会主文件数据。
我从 PLWH 的共同治疗中构建了区域性的医患共享网络，并计算了（a）与所有医生类型的网络联系程度的指标，以及（b）描述与艾滋病专家联系程度的专业加权指标。然后评估了两种艾滋病护理质量结果：药物质量（开至少两种药物类别的抗逆转录病毒药物）和监测质量（至少两次年度 HIV 病毒监测扫描）。线性概率模型估计网络统计数据与艾滋病护理质量的两个维度之间的关联，并进行政策模拟以展示这些统计关系的重要性。这些分析包括 16124 名 PLWH、3240 名普通科医生和 1031 名艾滋病专家。
数据收集/提取方法：通过使用现有文献中的算法从索赔中识别出具有任何 HIV 指征的患者中的 PLWH。
普通科医生与艾滋病专家的网络联系程度与其自身的艾滋病药物质量呈正相关；每增加一个艾滋病专家联系，普通科医生的药物质量就会增加 1.46 个百分点（SE 0.42，P<0.01）。根据估计的关联，如果实施一项增加普通科医生与艾滋病专家之间联系的模拟政策，每年可减少多达 6%的 HIV 感染率，即每年减少约 290 例感染。只有与所有医生类型的网络联系才与改善监测质量相关。
与艾滋病专家的网络联系程度与普通科医生的艾滋病药物质量呈正相关，这表明专家通过医患共享为复杂治疗方案提供临床支持。
