Disparities in outcomes among cancer patients who are rural-residing, with lower SES, and a racial minority
are well-documented and have garnered significant national media attention. Recent retrospective cohort
studies reported minimal rural/urban and racial disparities in outcomes when patients had uniform access to
care, highlighting the critical clinical importance of standardizing access to cancer care. Data made available
which evaluates access to specialists typically determines access based on a per capita count of individual
specialties, which does not adequately capture access to interdisciplinary teams of specialists. A relatively
unexplored area of study is the extent to which relationships between cancer specialists can be characterized
and then targeted to standardize access to cancer care, reduce cancer health disparities, and improve patient
outcomes. By assessing the relationships between physicians based on patient-sharing and geographic
proximity patterns observed in administrative data, we propose to apply our team’s expertise in network
analysis and cancer care to provide a framework for evaluating patient access to cancer care which recognizes
the coordination across medical oncology, radiation, and surgical specialists. We aim to develop and apply a
novel network measure– linchpin centrality – which identifies cancer specialists who are the only specialist of
their kind among their neighbors’ ties. We propose to evaluate variation of physician linchpin centrality by
cancer patient race and geographic variables, building on previous work demonstrating that racial disparities
vary significantly across US cities and rural subregions. We will further evaluate associations between
physician linchpin centrality and timely treatment and cancer mortality. One avenue for increasing access to
specialist care is through cancer specialists traveling to a secondary practice location, typically a rural hospital
in a community too small to support a full-time specialist. However, little is known about the impact of traveling
physicians on existing relationships between physicians and patient access to coordinated cancer care, a gap
in knowledge our proposal will address. In analyses specific to rural areas, we will assess the extent to which
physician travelers impact physician network structure and patient outcomes. Finally, we will conduct a
qualitative study to inform further development of linchpin centrality and a network algorithm as an intervention
to improve cancer care. The algorithm we develop will provide health systems with actionable data on the
organization of cancer care providers for their catchment and can help guide interventions and allocate
resources appropriately. In conclusion, this proposal uses network analysis to capture essential characteristics
of the quality of care for cancer patients, with the goal of bridging theory and practice to improve access and
outcomes with a network-guided intervention.
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