title: Physician social networks and variation in rates of complications after radical prostatectomy.
abstract: OBJECTIVE
  Variation in care within and across geographic areas remains poorly understood. The goal of this article was to examine whether physician social networks-as defined by shared patients-are associated with rates of complications after radical prostatectomy.
  
  
  METHODS
  In five cities, we constructed networks of physicians on the basis of their shared patients in 2004-2005 Surveillance, Epidemiology and End Results-Medicare data. From these networks, we identified subgroups of urologists who most frequently shared patients with one another. Among men with localized prostate cancer who underwent radical prostatectomy, we used multilevel analysis with generalized linear mixed-effect models to examine whether physician network structure-along with specific characteristics of the network subgroups-was associated with rates of 30-day and late urinary complications, and long-term incontinence after accounting for patient-level sociodemographic, clinical factors, and urologist patient volume.
  
  
  RESULTS
  Networks included 2677 men in five cities who underwent radical prostatectomy. The unadjusted rate of 30-day surgical complications varied across network subgroups from an 18.8 percentage-point difference in the rate of complications across network subgroups in city 1 to a 26.9 percentage-point difference in city 5. Large differences in unadjusted rates of late urinary complications and long-term incontinence across subgroups were similarly found. Network subgroup characteristics-average urologist centrality and patient racial composition-were significantly associated with rates of surgical complications.
  
  
  CONCLUSIONS
  Analysis of physician networks using Surveillance, Epidemiology and End Results-Medicare data provides insight into observed variation in rates of complications for localized prostate cancer. If validated, such approaches may be used to target future quality improvement interventions.
authors.affiliation: Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: cpollac2@jhmi.edu.
authors.forename: Craig
authors.initials: C
authors.lastname: Evan Pollack
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Gary
authors.initials: G
authors.lastname: Weissman
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Kaijun
authors.initials: K
authors.lastname: Liao
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Eva H
authors.initials: EH
authors.lastname: Dugoff
authors.affiliation: Massachussetts General Hospital, Boston, MA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare; D010820:Physicians / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D060756:Social Networking; D013997:Time Factors; D014481:United States; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D014572:Urology / Q000706:statistics & numerical data
keywords: cancer; claims data; health services; outcomes research