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Health Serv Res. 2019 Aug;54(4):880-889. doi: 10.1111/1475-6773.13151. Epub 2019 Apr 1.

Physician network position and patient outcomes following implantable cardioverter defibrillator therapy.

Author information

1
Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
2
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
3
Department of Economics and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.

Abstract

OBJECTIVE:

To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes.

DATA SOURCES:

Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011.

STUDY DESIGN:

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.

PRINCIPAL FINDINGS:

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.

CONCLUSIONS:

Degree centrality measures capture information independent of procedure volume and raise questions about the quality of physicians with networks that predict worse health outcomes.

KEYWORDS:

case fatality; degree centrality; implantable cardioverter defibrillator; physician network

PMID:
30937894
PMCID:
PMC6606612
[Available on 2020-08-01]
DOI:
10.1111/1475-6773.13151

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