To develop prostate cancer-specific physician-hospital networks to define hospital-based units that more accurately group hospitals, providers, and the patients they serve.
Using SEER-Medicare, we identified men diagnosed with localized prostate cancer between 2007 and 2011. We created physician-hospital networks by assigning each patient to a physician and each physician to a hospital based on treatment patterns. We assessed content validity by examining characteristics of hospitals anchoring the physician-hospital networks and of the patients associated with these hospitals.
We identified 42,963 patients associated with 344 physician-hospital networks. Networks anchored by a teaching hospital (compared to a non-teaching hospital) had higher median numbers of prostate cancer patients (117 (interquartile range [71-189] versus 82 [50-126]) and treating physicians (7 [4-11] versus 4 [3-6]) (both p <0.001). On average, patients travelled farther to networks anchored by a teaching hospital (49 miles (standard deviation) [207] versus 41 [183]; p<0.001). Hospitals known as high-volume centers for robotic prostatectomies, proton-beam therapy, and active surveillance had network rates for these procedures well above the mean. Hospitals known as safety net providers served higher proportions of minorities.
We empirically developed prostate-cancer specific physician-hospital networks that exhibit content validity and are relevant from a clinical and policy perspective. They have the potential to become targets for policy interventions focused on improving the delivery of prostate cancer care.
Urology. 2020 Jan 13 [Epub ahead of print]
Bruce L Jacobs, Jonathan G Yabes, Samia H Lopa, Dwight E Heron, Chung-Chou H Chang, Justin E Bekelman, Joel B Nelson, Julie P W Bynum, Amber E Barnato, Jeremy M Kahn
Department of Urology, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Department of Urology, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; Division of General Internal Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: ., Department of Urology, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI. Electronic address: ., Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH. Electronic address: ., Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: .